Novel apolipoprotein gene involved in lipid metabolism

ABSTRACT

Methods and materials for studying the effects of a newly identified human gene, APOAV, and the corresponding mouse gene apoAV. The sequences of the genes are given, and transgenic animals which either contain the gene or have the endogenous gene knocked out are described. In addition, single nucleotide polymorphisms (SNPs) in the gene are described and characterized. It is demonstrated that certain SNPs are associated with diseases involving lipids and triglycerides and other metabolic diseases. These SNPs may be used alone or with SNPs from other genes to study individual risk factors. Methods for intervention in lipid diseases, including the screening of drugs to treat lipid-related or diabetic diseases are also disclosed.

CROSS-REFERENCES TO PRIOR APPLICATION

This application is a divisional of U.S. patent application Ser. No. 10/229,834, filed Aug. 27, 2002 which claims priority to Application No. 60/315,210, which was filed on Aug. 27, 2001, the disclosure of which are hereby incorporated by reference in their entirety for all purposes.

STATEMENT OF GOVERNMENT SUPPORT

This invention was made during work supported in part by the U.S. Department of Energy, Office of Biological and Environmental Research, under Contract No. DE-ACO3-76SF00098. The government has certain rights in this invention.

REFERENCE TO SEQUENCE LISTING

Applicants assert that the paper copy of the Sequence Listing is identical to the Sequence Listing in computer readable form found on the accompanying computer disk. Applicants incorporate the contents of the sequence listing by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention generally relates to human lipid metabolism, particularly to apolipoproteins, genes encoding these apolipoproteins, related proteins, and their mutations and polymorphisms as they relate to cardiovascular, coronary and other diseases.

2. Description of the Related Art

Cardiovascular diseases are the number one cause of death in Western societies. Studies repeatedly show that individuals with high levels of very low-density lipoprotein, (VLDL) and/or low levels of high density lipoprotein (HDL) have significantly increased chances of developing cardiovascular disease. It has been established that strategies to reverse the levels of these lipoprotein particles will lower disease risk in susceptible individuals.

Lipoproteins function as transport vehicles for triacylglycerols (triglycerides), cholesterol and other lipids. These complexes solubilize highly hydrophobic lipids, and regulate entry and exit of particular lipids at specific targets. Lipoproteins form micelle-like particles that consist of a nonpolar core of triacylglycerols, more commonly known as triglycerides, and cholesteryl esters surrounded by a coating of protein, phospholipids, and cholesterol. The lipoproteins are classified according to density. Lipoprotein particles are composed of lipids and proteins and are such particles as chylomicrons, very low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). (Voet and Voet, Biochemistry, 1990; Stryer, Biochemistry, 1995). The protein components of lipoproteins are known as apolipoproteins.

Van der Vliet, H N et al., report on a gene that shares homology to APOAV and note its increase in expression following rat liver hepatectomy in J Biol Chem. 2001 Nov. 30; 276(48):44512-20. The rat (GenBank Accession Nos. AF202888 and AF202887), mouse (GenBank Accessions No. AF327059) and human (GenBank Accessions Nos. AF202890 and AF202889) versions of these sequences were deposited in GenBank and entitled, Regeneration-associated protein 3 (Rap 3) mRNA, complete cds. Rap3 is noted in GenBank as an “apolipoprotein-like serum protein; concentration elevated after a 70% partial hepatectomy” in rats.

The human genomic region containing the DNA sequence for APOAV was sequenced by the Human Genome Project and deposited in GenBanK under Accession Numbers AC007707 and/or AC074203. These deposits cover approximately 200 kb of human genomic DNA. The deposits are associated with clustered 11q23 and 22q11 breakpoints, but no coding regions are described. Computational analyses indicate the previously described APOA-I, APOC-III, and APOA-IV are contained within this interval.

The GenBank Accession Number AC007707 sequence shows the opposite strand (reverse complement) of the sequences of the present invention. The reverse complement of AC007707 was used as the starting point of the present invention for finding the APOAV gene and coding sequence.

Yen et al., in PCT Publication WO 01/007803, entitled “Apolipoprotein A-IV-related protein: Polypeptide, polynucleotide sequences and bi-allelic markers thereof” describe a gene corresponding to the present APOAV. The gene is described as encoding an apolipoprotein A-IV-related protein (AA4RP) as well as regulatory sequences at the 5′ and 3′end. Also disclosed are biallelic markers of the AA4RP gene useful in genetic analysis. However, Yen et al. describe their biallelic markers differently than the SNP's of the present invention. They disclose no description of any known linkages between these markers and any known disease phenotype.

Several human cDNA sequences derived from the APOAV gene have been previously disclosed in GenBank. A sequence file generated by the NCBI annotation project in July 2001 (transcript version 1) is disclosed as human mRNA/cDNA sequence, XM_(—)052110. A second sequence file generated by the NCBI annotation project identifies in July 2001 (transcript version 2) can be found as XM_(—)052109. AF202890 (called RAP3) is a third cDNA sequence that is related to the van der Vliet et al. Human ortholog of rat liver regeneration associated protein (transcript version 1). AF202889 (called RAP3) is the fourth cDNA sequence related to the van der Vliet et all. No. AF401201 and was made public on 7 Oct. 2001.

Other related sequences include mouse mRNA/cDNA sequence (AF327059), called RAP3, which is the sequence identified as the mouse ortholog of rat liver regeneration associated protein. Three publicly generated mouse full-length cDNAs for apoAV are found under the following Accession Nos.: AK004903 (transcript version 2), BC011198 (transcript version 2), and AK004936 human ortholog of rat liver regeneration associated protein (transcript version 2).

Human protein sequences were predicted from mRNA sequences AF202890 and AF202889 and called AAF25662 and AAF25661, which correspond to the APOAV protein, which can be found under NP_(—)443200 in NCBI.

The mouse genomic region (which includes additional genes sequenced and used to create the knock-out mice described herein) is SEQ ID NO: 7 in this application. This sequence was deposited in GenBank under GenBank Accession (transcript version 1). The mouse RAP3 protein (GenBank Accession No. AAG49600) is the protein sequence predicted from mRNA sequence AF327059.

BRIEF SUMMARY OF THE INVENTION

The present invention involves a human apolipoprotein gene and its expressed product, Apolipoprotein A-V (herein referred to as “APOAV” or “APOA5”), located near a previously described apolipoprotein AI/CIII/AIV gene cluster (a region repeatedly implicated in various cardiovascular diseases) and its association with elevated levels of triglycerides.

The various aspects of the invention, as described below, are useful in the genetic analysis of cardiovascular disease. Patients with genetic predispositions to certain conditions may be screened with the analyses provided herein. High levels of APOAV protein expression are associated with lowered triglyceride levels, and low levels of APOAV expression (as demonstrated in “knock-out mice”) are associated with increased levels of triglycerides. Furthermore, various polymorphisms have been identified which are correlated with different plasma triglyceride levels. Specifically, individuals with minor alleles for several SNPs near APOAV consistently display increased plasma triglyceride levels.

In addition, the present invention involves identification of a strong association between uncommon alleles of SNPs in the APOAV gene and increased plasma triglyceride levels in the general human population. Thus the present invention enables genetic testing for APOAV variants and their correlation to increased triglyceride levels in people having APOAV polymorphisms deviating from the normal or “wild type” phenotype. Further, a combination test APOCIII is suggested. Genetic testing may be carried out on a patient's DNA or RNA or protein, provided that antibodies capable of distinguishing mutant from wild type APOAV protein are available. Furthermore, genetic testing using the markers disclosed herein may be used to identify individuals at risk for diabetes and/or insulin resistance. Genetic testing may also be used to determine an individuals' susceptibility to Familial hypercholesterolemia or other forms of hypercholesterolemia.

The invention also provides means for identifying haplotypes that are linked to the diseases of hyperlipidemia (CHL) and familial combined hyerlipidemia (FCHL).

Association studies indicate the existence of three haplotypes (APOA5*1, APOA5*2, APOA5*3) in APOA present in the general human population, that are associated with triglycerides. These three haplotypes are composed of five biallelic markers (SNPs 1-3, 5, and 6).

Thus, the invention includes using various methods for screening for genetic APOAV haplotypes or SNPs in humans. Fragments of various lengths of APOAV SEQ ID NOS: 1-7 may be placed onto solid supports for use in gene chips or other parallel formats for assay purposes. The sequences used will span a SNP and have sufficient flanking bases for specificity and binding, e.g. 10 bases on either side (5′ and 3′) of the nucleotide bearing the SNP. As few as 2 and as many as 1,000 bases may be used, depending on test design considerations.

Other methods for diagnostic purposes in this invention include but are not limited to, making antibodies to APOAV and its variants, attachment of the APOAV sequences disclosed herein onto solid supports for array and gene chips, and other hybridization assays.

The invention provides non-human animals that over-express the human version of APOAV. The over-expression of this gene results in these animals having dramatically reduced plasma triglyceride levels (˜3-fold). In addition to decreased triglyceride levels these mice also have corresponding decreases in VLDL levels.

The invention also provides homozygous knockout non-human animals that are lacking apoA5 and therefore do not produce apoA5 protein. These animals have increased and VLDL and triglyceride levels. This invention also includes recombinant vectors and DNA targeting constructs, such as the one used by the inventors to delete mouse apoA5 and was built using PCR products and primers made from SEQ ID NO: 7.

This invention also provides non-human animals for further animal studies by pharmaceutical companies to study human or mouse apoA5. Animal studies that explore the regulation and expression of human or mouse apoA5, its interaction with other apolipoproteins, production of antibodies for mutant and wild-type apoA5, and further in vivo study of apoA5. For example, mice lacking wild-type apoA5 may be exposed to various test substances to determine the triglyceride lowering effect of the test substance on individuals having a non-wild-type apoAV gene. The invention provides non-human animals useful for studying apoCIII since its levels are altered in these mouse models.

The invention can be further characterized as including an isolated polypeptide wild type APOAV protein as set forth in SEQ ID NO: 4, which corresponds to the ideal normal APOA5*1 haplotype. One mutant protein is encoded by DNA carrying the uncommon SNP5, described below as variation SNP5 at position 12974 is set forth in SEQ ID NO: 3 and corresponds to haplotype APOA5*3.

Another aspect of the invention is that stratification of populations based on APOA5 markers may identify a subset of individuals that respond differently to current and future drug therapies. These studies would contribute in understanding which of these drug therapies or combinations of drug therapies are the most beneficial to lower triglyceride levels in individuals having haplotypes APOA5*1, APOA5*2 or APOA5*3.

The SNPs disclosed herein can also be studied for association with other diseases including, but not limited to, diabetes, obesity, metabolic syndrome, or other generic disorders. The inter-relatedness of these conditions is well established in the literature. APOA5-increased expression or other means for protein delivery may prove to be successful to treat numerous symptoms of these diseases.

This invention also provides the means of combination therapy which uses high levels of APOAV expression or protein regardless of genotype or haplotype to treat any condition of high triglycerides. This strategy could also be combined with stratification-based studies. A further aspect of the invention is gene therapy to deliver active drugs to liver cells to over-express APOAV and thereby decrease triglycerides. Delivery of APOAV therapies can be by such methods as but not limited to, injection of active APOAV, delivery by pill form, and inhalation by spray to deliver APOAV to lungs and the blood to reduce triglycerides.

The inventions also encompasses drug screening and design of therapeutic agents to be used in methods for increasing APOAV expression, and thereby lowering triglycerides, based on the APOAV polynucleotides and polypeptides described herein is also an important aspect of the invention, especially in the identification of genes, regulatory elements, ligands, drugs and other therapeutic agents to be used to modulate and regulate APOAV expression. Such therapeutic agents include current drug therapies for high triglyceride levels such as fibrates or other drug agents which are known to reduce triglycerides.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. A diagram showing the genomic organization of the human APOAI/CIII/AIV cluster (1a) and VISTA plot showing similarities between the mouse and human sequences in this region.

FIG. 2. A diagram of the targeting construct used to generate apoA5-deficient mice. Homology arms were designed to delete the coding exons of the gene (depicted by black boxes).

FIG. 3. Bar charts showing plasma triglyceride and cholesterol for human transgenic (FIG. 3A) mice and apoAV knockout mice (FIG. 3B).

FIG. 4. (A) New SNP map of the APOAV genomic locus. Exons are depicted by rectangles with coding sequence filled in with black and untranslated regions with white. The gene is transcribed in the right to left direction. (B) Minor allele frequencies are approximately 10% in Caucasians for SNPs 1, 2, 3, 5, 6, and ˜40% for SNP4. Minor alleles for SNPs 1, 2, 3, and 6 form a common haplotype (˜10%). SNP5 is part of a second independent haplotype (˜10%).

FIG. 5. Table of genotyping data from 501 individuals (A); pair-wise measures of linkage disequilibrium (B); and SNP3 genotyping data from a different set of individuals stratified by triglyceride levels (C).

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT Definitions

The term “triglycerides” is used in its ordinary medical sense. However, the tests of the present invention for disposition towards elevated triglyceride levels may also include elevated triacylglycerol, cholesterol, and other related lipid levels, very low density lipoprotein (VLDL) levels, or levels of other closely related apolipoproteins or lipoprotein particles such as chylomicrons, intermediate density lipoprotein (IDL), or low density lipoprotein (LDL) or high density lipoprotein (HDL) levels.

“Single nucleotide polymorphisms” (SNPs), which are defined in relation to a population, are variations in DNA at a single base that are found in at least 1% of the population. The terms “biallelic marker,” “marker,” “polymorphism” and “allele” are also used to denote variations at a single base and are used interchangeably.

The term, “genotype,” is used herein to mean a specific allele or alleles an individual carries at a given locus. It can also be used to describe a set of alleles for multiple loci.

A “haplotype” is a set of alleles for closely spaced polymorphisms along a chromosome that tend to be inherited together. Alternatively a haplotype can be thought of as a combination of alleles of closely linked loci that are found in a single chromosomal interval and tend to be inherited together. An individual SNP allele can be used to define a given haplotype.

The term “phenotype,” is used herein to mean the form taken by some character (or group of characters) in a specific individual. It can also mean the detectable outward manifestations of a specific genotype.

The term, “proband” is used to mean an affected individual in a family.

The term, “allele” is used herein to mean one of the different forms of a gene that can exist at a single locus. An allele is also used to describe a given version of a polymorphism.

The term, “allele frequency” is used to mean a measure of the commonness of an allele in a population, the proportion of all alleles of that gene or polymorphism in the population that are of this specific type.

The term, “Hardy-Weinberg” is used to refer to calculating the Hardy-Weinberg equilibrium for genotypes, whereby the stable frequency distribution of genotypes AA, Aa, and aa, in the proportions p², 2pq and q², respectively (where p and q are the frequencies of the alleles A and a), that is a consequence of random mating in the absence of mutation, migration, natural selection or random drift.

The term “P-value” is used herein to mean the probability that the results were not significant. For example, a p-value of 0.05 means that there are 5 chances in 100 that the results are not significant.

The term, “SEM” is used to mean the standard of the mean.

The term “linkage disequilibrium” is used herein to refer to the relationship that is said to exist between a allele found at a single polymorphic site and alleles found at nearby polymorphisms if the presence of one allele is strongly predictive of the alleles present at the nearby polymorphic sites. Thus, the existence of linkage disequilibrium (LD) enables an allele of one polymorphic marker to be used as a surrogate for a specific allele of another.

“Substantial homology or similarity” means that a nucleic acid or fragment thereof is “substantially homologous” (or “substantially similar”) to another if, when optimally aligned (with appropriate nucleotide insertions or deletions) with the other nucleic acid (or its complementary strand), using BLASTN there is nucleotide sequence identity in at least about 60% of the nucleotide bases, usually at least about 70%, more usually at least about 80%, preferably at least about 90%, and more preferably at least about 95-98% of the nucleotide bases. To determine homology between two different nucleic acids, the percent homology is to be determined using the BLASTN program “BLAST 2 sequences”. This program is available for public use from the National Center for Biotechnology Information (NCBI) over the Internet (Altschul et al., 1997). The parameters to be used are whatever combination of the following yields the highest calculated percent homology (as calculated below) with the default parameters shown in parentheses:

-   Program—blastn -   Matrix—0 BLOSUM62 -   Reward for a match—0 or 1 (1) -   Penalty for a mismatch—0, −1, −2 or −3 (−2) -   Open gap penalty—0, 1, 2, 3, 4 or 5 (5) -   Extension gap penalty—0 or 1 (1) -   Gap x_dropoff—0 or 50 (50) -   Expect—10

The terms “substantial homology” or “substantial identity”, when referring to polypeptides, indicate that the polypeptide or protein in question exhibits at least about 30% identity using BLASTP with an entire naturally-occurring protein or a portion thereof, usually at least about 70% identity over the common lengths, more usually at least about 80% identity, preferably at least about 90% identity, and more preferably at least about 95% identity.

Homology, for polypeptides, is typically measured using sequence analysis software. See, e.g., the Sequence Analysis Software Package of the Genetics Computer Group, University of Wisconsin Biotechnology Center, 910 University Avenue, Madison, Wis. 53705. Protein analysis software matches similar sequences using measures of homology assigned to various substitutions, deletions and other modifications. Conservative substitutions typically include substitutions within the following groups: glycine, alanine; valine, isoleucine, leucine; aspartic acid, glutamic acid; asparagine, glutamine; serine, threonine; lysine, arginine; and phenylalanine, tyrosine.

The term “polynucleotide” refers to a chain of nucleotides without regard to length of the chain.

The term “polypeptide” refers to a polymer of amino acids without regard to the length of the polymer; thus, peptides, oligopeptides, and proteins are included in this term.

A. Sequences of Apolipoprotein A-V

Despite the previous availability of sequence in the human apoAI/CIII/AIV genomic interval, the gene APOAV was characterized by human/mouse sequence comparison, using the power of comparative sequence analysis to prioritize potential functional regions of the genome. APOAV represents a fourth member of the clinically important apolipoprotein gene cluster on human 11q23. The human and mouse data, both when taken independently and combined, indicate an important role for APOAV in plasma triglyceride homeostasis. While previous data have associated the apoCIII locus with extremely high plasma triglyceride levels in humans, the results of the present studies suggest the possible use of APOAV polymorphisms as prognostic indicators for hyper-triglyceridemia susceptibility and the focus on APOAV modulation as a potential strategy to reduce this known cardiovascular disease risk factor.

FIG. 1 shows human and mouse comparative sequence analysis of the apoAI/CIII/AIV gene cluster. (A) A schematic of the genomic organization of human APOAV and the relative SNP positions (arrows). APOAV exons are shown with solid boxes and the distance between each SNP is indicated above the line. The predicted transcription start site is depicted by a bent arrow and the relative position of the promoter, and start and stop codons are shown. (B) In each panel 30 kbp of contiguous human sequence is illustrated horizontally. Above each panel arrows correspond to known genes and their orientation with each exon depicted by a box (gene names are indicated above each arrow). The VISTA (VISualization Tools for Alignment) plot displays the level of homology between human and the orthologous mouse sequence. Human sequence is represented on the x-axis and the percent similarity with the mouse sequence is plotted on the y-axis (ranging from 50-100% identity).

A preferred embodiment involves a human apolipoprotein gene, APOAV, located near a previously described apolipoprotein AI/CIII/AIV gene cluster (a region repeatedly implicated in various cardiovascular diseases). Electronic homology searches with human apoAI, apoCIII, and apoAIV mRNA sequences using the BLAST algorithm (S. F. Altschul, W. Gish, W. Miller, E. W. Myers, D. J. Lipman, J Mol. Biol 215, 403-10 (1990)) identified a genomic bacterial artificial chromosome (BAC) clone containing the complete apoAI/CIII/AIV gene cluster (GenBank Accession No. AC007707).

The predicted 368-amino acid sequence shows significant homology to various known apolipoproteins, with the strongest similarity to mouse apoAIV (24% identity and 49% similarity). Examination of the orthologous human genomic sequence indicates a similar genomic structure to the mouse region and predicts an open reading frame encoding a 366-amino acid protein with high sequence homology to mouse apoAV (71% identity and 78% similarity), as well as human apoAIV (27% identity, 48% similarity). Protein structure analyses predicts several amphipathic helical domains and an N-terminal signal peptide in both human and mouse APOAV, which are characteristic features of lipid-binding apolipoproteins.

Transcripts approximately 1.3- and 1.9-kilobases (kb) in length were identified predominantly in liver tissue from both species by Northern blots analysis, where mRNA from several different human and mouse tissues was hybridized with APOAV cDNA probes from human and mouse, respectively. The full-length sequences of mouse cDNAs indicate the two transcripts in mice are likely the result of alternative polyadenylation. The mouse apoA5 cDNA sequences are available under GenBank Accession Nos. AK004936 and AK004903.

(1) Brief Description of the Sequences (SEQ ID NOS: 1-48)

SEQ ID NO: 1 and 2 are cDNA sequences corresponding to the coding sequence of a “wild type” APOAV gene and are deposited in GenBank under Accession No. AF202889.1 and F202890.1. Both cDNAs contain the normal wild type alleles. SEQ ID NO: 1 is a 1.3 kb transcript of the APOAV gene. SEQ ID NO: 2 is an alternatively spliced 1.8 kb transcript of the APOAV gene. The protein is encoded on the reverse complement. SNP5 is the only SNP in the group that changes an amino acid (Serine (S 19)→Tryptophan (W19)) at position 19 of the putative protein. The substitution of G for A in SNP6 is in a critical nucleotide of the Kozak consensus sequence (−3 bp).

SEQ ID NO: 3 is the human genomic sequence comprising the present wild type APOAV gene, certain of its regulatory elements, and the SNPs associated with the genomic sequence. The indicated SNPs are numbered as follows: SNP 4, 3, 6, 5, 2, 1 in the order in which they appear in the sequence. The following table indicates the base pair positions in SEQ ID NO: 3 where these polymorphisms are found. Profiles for each of these SNPs can be found in GenBank under the following Accession Numbers: 2266788 (SNP1), 2072560 (SNP2), 662799 (SNP3), 3199916 (SNP4), 3135506 (SNP5), 651821 (SNP6) and 3135507 (V153M).

TABLE 1 SNPs shown in SEQ ID NO: 3 SNP Position Number Original allele > number in SEQ ID NO: 3 Rare allele Location in APOA5 4 567 T > C Between APOA5 and APOA4 3 11674 T > C Upstream 6 12802 A > G 5′ untranslated region 5 12974 C > G causing an amino acid change in the APOA5 gene product (S19 → W19) 2 13555 G > A Intervening sequence 3 + 476 1 14695 T > C Coding sequence 1259

SEQ ID NO: 3 and 4 are annotated to show certain regulatory regions (CAAT box and TATAA box); the exons; and start and stop codons and the untranslated regions.

SEQ ID NO: 4 is the ideal wild type genomic sequence of human APOAV gene and contains the alleles in their major form, as do the corresponding GenBank sequences.

SEQ ID NO: 5 is the human DNA sequence used to create the transgenic mice expressing human APOAV. This sequence has not been deposited in GenBank.

SEQ ID NO: 6 is the working draft sequence of the mouse apoA5 that was deposited by the inventors in GenBank and recently released for publication to the public. It is the mouse genomic apoA5 region used to generate the homozygous knock-out mice. It consists of 75 unordered and unoriented contigs, wherein the gaps of unknown length are denoted as an ‘n’ in the sequence.

SEQ ID NO: 7 is the amino acid sequence of the protein product generated from SEQ ID NO: 4. A suitable wild-type APOAV protein is set forth in SEQ ID NO: 7. One mutant protein is encoded by DNA carrying the uncommon SNP5, is set forth in SEQ ID NO: 3.

SEQ ID NOs: 8-9 are the forward and reverse primers used to isolate mouse genomic DNA in Example 1 from the pooled mouse BAC library.

SEQ ID NOs: 10-11 are the forward and reverse primers used to genotype transgenic mouse for the human APOAV gene.

SEQ ID NOs: 12-15 are the PCR primers that were used to build the homology arms in the targeting construct to delete mouse apoA5 in knockout mice.

SEQ ID NOs: 16-17 were used to amplify the external 3′ probe when creating the apoA5 knockout animals.

SEQ ID NOs: 18-19 and SEQ ID NOs: 37-38 are the primers used to genotype the apoA5 knockout animals. SEQ ID NOS: 18-19 are the forward and reverse primers to genotype for the presence of the apoA5 gene.

SEQ ID NOs: 20-21 are the forward and reverse primers used to amplify and genotype SNP3.

SEQ ID NOs: 22-23 are the degenerate primers used to genotype the transgenic animals for the presence of APOAV and to probe PCR amplified liver cDNA for human or mouse APOAV cDNAs.

SEQ ID NOs: 24-25 are the forward and reverse primers used to genotype SNP5. SEQ ID NOs: 26-27 are the reverse and forward primers used to genotype the V153M polymorphism.

SEQ ID NOs: 28-36 are the probes and INVADER sequences used to perform the INVADER assays to genotype SNPs 5, 6 and V153M.

SEQ ID NOs: 37-38 are the forward and reverse primers used to genotype the presence of the neomycin gene in preparing the apoA5 knockout mice.

SEQ ID NOs: 39-48 are primers used to genotype the six SNPs as shown in Table 3.

SEQ ID NOs: 39-40 are the forward and reverse primers used to amplify or genotype SNP1.

SEQ ID NOs: 41-42 are the forward and reverse primers used to amplify or genotype SNP2.

SEQ ID NOs: 43-44 are the forward and reverse primers used to amplify or genotype SNP5.

SEQ ID NOs: 45-46 are the forward and reverse primers used to amplify or genotype SNP3 and SNP6.

SEQ ID NOs: 47-48 are the forward and reverse primers used to amplify or genotype SNP4.

(2) Applications for APOAV Sequences

In another embodiment, a polynucleotide fragment is also contemplated wherein the fragment comprises a contiguous span of at least 12 nucleotides of SEQ ID NO: 3, where said contiguous span encompasses one or more SNPs 1-3, 5 or 6 as described in SEQ ID NO: 3.

A further preferred embodiment consists of a purified, isolated, synthesized or recombinant nucleic acid that hybridizes with an SNP nucleotide-containing the nucleotide sequence of SEQ ID NOs: 3 or 5, or a complementary sequence or a variant that is substantially homologous.

B. APOAV DNA Constructs and Recombinant Vectors

The present embodiment encompasses a recombinant vector comprising a polynucleotide that is substantially homologous to any of the polynucleotides described herein, including regulatory sequences, coding sequences and polynucleotide constructs, as well as any APOAV primer or probe. In a first preferred embodiment, a recombinant vector comprises expression vectors comprising either a regulatory polynucleotide of APOAV or a coding nucleic acid of the present embodiment, or both. Within some embodiments, the expression vectors are employed in the in vivo expression of APOAV in non-human animals. In other embodiments, the expression vectors are used for constructing transgenic animals and gene therapy.

Depending on the host organism or cell wherein the APOAV gene will be expressed, one skilled in the art can adapt the recombinant vector to further comprise genetic elements, including but not limited to, an origin of replication in the desired host, suitable promoters and enhancers, any necessary ribosome binding sites, polyadenylation signal, splice donor and acceptor sites, transcriptional termination sequences, selectable markers and non-transcribed flanking sequences. Various types of gene delivery vectors can be used including, but definitely not limited to, plasmids, YACs (Yeast Artificial Chromosomes), BACs (Bacterial Artificial Chromosomes), bacterial vectors, bacteriophage vectors, viral vectors (for example, retroviruses, adenoviruses and viruses commonly used for gene therapy), non-viral synthetic vectors, and recombinant vectors, etc.

A second embodiment comprises a host cell that has been transformed or transfected with one of the APOAV polynucleotides described herein, in particular a polynucleotide comprising SEQ ID NO: 1, 2 or 5 or a fragment or variant thereof. Appropriate host cells can be prokaryotic host cells, such as E. coli, Bacillus subtilis, Salmonella typhimurium, and strains from species including but not limited to, Pseudomonas, Streptomyces and Staphylococcus. Alternatively eukaryotic host cells can be used, including but not limited to, HeLa cells, HepG2 and other mammalian host cells. A preferred embodiment is a mammalian host cell comprising the APOAV genomic region, wherein the APOAV gene is disrupted by homologous recombination with a knockout vector.

In order to study the physiological and phenotypic consequences of a lack of synthesis of the APOAV protein, both at the cellular level and at the organism level, the preferred embodiment also encompasses DNA constructs and recombinant vectors enabling conditional expression of a specific allele or haplotype of the APOAV genomic sequence as described in SEQ ID NO: 3, 5 or 6 or an APOAV cDNA (SEQ ID NO: 1, 2) in a transgenic non-human animal. The embodiment also encompasses DNA constructs to generate animals having multiple copies of the APOAV protein expressed and animals having no APOAV protein that is expressed (“knock-out animals”).

The targeting construct can be built by various methods known in the art including but not limited to, PCR primers for integration by homologous recombination, using a represssor/marker promotor construct, Cre-LoxP system, and antisense constructs. The method preferred is using PCR products and primers to build the targeting construct. To build such a construct to make knockout non-human animals and cells, one would need the homology “arms” that flank each side of the sequence to be deleted or disrupted, and a selectable marker inserted between the arms to select for the marker function. The sequence to be deleted can be the whole APOAV gene as the inventors did in Example 3, single or multiple exons, intervening genomic sequences, short peptide sequences and even single base pair deletions. After delivery of the construct into embryonic stem cells, selection for the marker permits gene deletion. Or for instance, APOAV gene function can be disrupted by insertion of the selectable marker, by inserting insertion of the marker in the promoter, splice sites, or the open reading frame.

To make transgenic non-human animals, designing the construct should include as much flanking sequence of APOAV as to include all the regulatory elements that may be found in the flanking genomic DNA. One needs to consider the neighboring genes and whether or not they should be over-expressed as well. See Thomas, K. R. and Capecchi, M. R., Site-directed mutagenesis by gene targeting in mouse embryo-derived stem cells. Cell 51:503, 1987.

Thus in a specific embodiment, SEQ ID NO: 5, which is the 26 Kb XhoI isolated polynucleotide of the human APOAV region, can be used to create constructs that includes APOAV and APOAV flanking sequence but does not include neighboring APO genes. In a preferred embodiment, the targeting construct to delete mouse apoAV can be built using PCR products and primers made from SEQ ID NO: 7. For example, apoA5 knockout mice were generated by deleting the three exons predicted to encode apoA5 (FIG. 1A, FIG. 2).

In order to effect expression of the polynucleotides and polynucleotide constructs preferred embodiment, these constructs must be delivered to the host cell, where once it has been delivered to the cell, it may be stably integrated into the genome of the host cell and effectuate cellular expression. This delivery can be accomplished in vitro, for laboratory procedures for transforming cell lines, or in vivo or ex vivo, for the creation of therapies or treatments of diseases. Mechanisms of delivery include, but are not limited to, viral infection (where the expression construct is encapsulated in an infection viral particle), other non-viral methods known in the art such as, calcium phosphate precipitation, DEAE-dextran, electroporation, direct micro-injection, DNA-loaded liposomes, and receptor-mediated transfection of the expression construct. In a preferred embodiment, the delivery of the construct is by micro-injection into the appropriate host cell or by intravenous injection in the organism.

C. Correlation of APOAV Sequence Variants with Human Plasma Triglyceride Levels

Single nucleotide polymorphisms (SNPs) were first identified across and surrounding the human APOAV locus to serve as genetic markers for association. Six markers with relatively high minor allele frequencies (>8%) were obtained. Five of the SNPs were separated by three kbp within APOAV (SNP1-3, 5 and 6), while the fourth SNP (SNP4) was located ˜11 kbp upstream of the gene (FIG. 1A). These markers were scored in approximately 500 random unrelated normo-lipidemic Caucasian individuals who had been phenotyped for numerous lipid parameters before and after consumption of high- and low-fat diets.

Significant associations were found between both plasma triglyceride levels and VLDL mass and the five neighboring SNPs 1-3, 5 and 6 within APOAV but not with the distant upstream SNP4 (FIGS. 1A, 5A). Specifically, the minor allele of each of these SNPs (SNPs1-3, 5 and 6) was associated with higher triglyceride levels independent of diet. Independent analysis of each of SNPs 1-3, 5 and 6 revealed plasma triglyceride levels were 20-30% higher in individuals having one minor allele compared to individuals homozygous for the major allele (FIG. 4A). Two independent groups of individuals displayed increased triglycerides. First is a group of individuals with minor alleles at SNPs1-3, 6, while the second group of individuals contained the minor allele at SNP5.

Since the Caucasian population has two different apparent causative chromosomes for increased triglycerides and the allele frequency is ˜8% for both haplotypes, this observation effects a large number of individuals in the general population. (A minor allele frequency of 8% means there is an 8% probability for the rare haplotypes to occur on each chromosome.) Based on Hardy-Weinberg, the expected genotype distributions for such SNPs in the population can be calculated yielding 84.6% homozygous for the major allele, 14.7% heterozygous,

D. Transgenic Non-Human Animals to Assess Function of APOAV

The preferred embodiment also provides non-human animals to assess APOAV function. These non-human animals are preferably mammalian, even more preferably from the group consisting of mouse, rat, dog, chimpanzee, orangutan, baboon and macaque. These non-human animals are most preferably of the species Mus musculus, over-expressing human APOAV, as well as mice lacking apoA5 through standard mouse transgenic and gene knockout technologies (FIG. 2) (See K. A. Frazer, G. Narla, J. L. Zhang, E. M. Rubin, Nat Genet 9, 424-31 (1995) and C. Paszty, et al., Nat Genet 11, 33-39 (1995)). apoA5 knock-out animals and transgenic animals exhibit dramatic, but opposite effects on plasma triglyceride levels. apoA5 knockout animals exhibit a hyper-triglyceride phenotype, while the APOAV transgenic animals which over-express APOAV protein, exhibit a hypo-triglyceride phenotype.

APOAV transgenic animals, depending on the genetic background and the amount of overexpression, should exhibit at least two fold lower levels of plasma triglyceride. Multiple copies of the human APOAV gene result in an observed over-expression of the APOAV gene which can be determined by Northern blot analysis and result in reduced plasma triglyceride levels.

In addition to decreased triglyceride levels APOAV transgenic non-human animals should also have corresponding decreases in VLDL levels. This finding is consistent with the general knowledge that the majority of plasma triglyceride is carried on VLDL particles. VLDL levels can be characterized by fast protein liquid chromatography of lipoprotein particles from the animals or by other standard methods of lipoprotein determination such as ultracentrifugation.

An alternate embodiment also provides homozygous knockouts that are lacking apoA5 protein or lacking functional apoA5 protein. Transformed or transgenic cells, cell lines or non-human animals are obtained by homologous recombination of at least one apoA5 exon in embryonic stem cells, transfer of these stem cells to embryos, selection of the chimeras affected at the level of the reproductive lines, and growth of the said chimeras. Following successful germ-line transmission, heterozygous animals are then intercrossed.

The levels of very low-density lipoprotein (VLDL) particles increase in homozygous knockout animals and decrease in transgenic animals as compared with controls. Heterozygous knockout animals should exhibit VLDL levels intermediate between the homozygous knockout and control mouse. The peak VLDL elution volumes should remain similar in all animals, supporting comparable VLDL particle size, and that levels of other lipoproteins are not significantly altered.

To generate non-human animals which over-express APOAV, SEQ ID NO: 5, which is a 26.6 kbp XhoI human genomic DNA fragment predicted to contain only human APOAV, can be integrated into the genome of non-human embryos, thereby resulting in the expression of several copies of the human APOAV gene by the non-human animals. In addition, transgenic animals such as rats and rabbits, or transgenic continuous cell lines can be made. Furthermore, transgenic animals can be made using cDNA encoding human APOAV, both in its wild type and variants as described herein.

Transgenic non-human animals over-expressing the APOAV gene could be obtained by transfection of multiple copies of said APOAV gene under the control of a strong promoter of an ubiquitous nature, or promoters selective for a type of tissue, preferably liver tissue.

This embodiment also provides non-human animals for further animal studies by pharmaceutical companies to study APOAV. Animal studies that explore the regulation and expression of APOAV, its interaction with other apolipoproteins or other plasma, membrane or cellular proteins, production of antibodies for mutant and wild-type apoA5, and further in vivo study of apoA5. For example, mice lacking wild-type apoA5 may be exposed to various test substances to determine the triglyceride lowering effect of the test substance on individuals having a non-wild-type apoA5 gene. If a certain drug is no longer able to work, it would indicate that apoa5 is needed for the given drug to exert its affect.

Preferably, said transformed cells or mammals of the preferred embodiment will be used as a model allowing, in particular, the selection of products which make it possible to combat the pathologies induced by high levels of triglycerides.

In another embodiment, the non-human animals can be used to reveal the mechanism behind how apoA5 exerts its affect. Studies using the non-human animals can enable the elucidation of different mechanisms of triglyceride regulation, including but not limited to, clearance from the liver, secretion, production, catabolism and lipolysis of triglycerides. For example, to study clearance, one can identify a liver receptor or an alteration in the rate of VLDL clearance from the liver that apoA5 works through, which would prove to be a significant future target for drugs. The non-human animals may be used to show how apoA5 works in the liver to move triglycerides from the liver to the plasma, or if it is involved in increased lipolysis in the peripheries, or whether apoA5 has an effect on inflammation that leads to altered triglyceride levels.

E. Effects on Other Apolipoproteins in Transgenic Non-Human Animals

The observed changes in plasma triglyceride levels in apoA5 knockout and transgenic animals are directly opposite those previously reported in apoC3 knockout and transgenic mice (Y. Ito et al., Science 249, 790-3 (1990); N. Maeda, et al., J Biol Chem 269, 23610-6 (1994)). The apoA5 knockouts displayed an approximately 400% increase in plasma triglycerides compared to the 30% decrease noted in ApoC3 knockouts, while apoA5 transgenics showed decreased triglyceride levels compared to the increase reported in apoC3 transgenics.

The transgenic mice over-expressing human APOAV showed a decrease in apoCIII levels thereby suggesting a mechanism behind APOAV's effect on plasma triglyceride levels. Furthermore, mice lacking APOAV have increased apoCIII levels. Whether this direct association is coincidence or causal of the triglyceride phenotype remains to be determined.

Altered apoA5 expression affects apoC3 protein but not transcript levels in both apoA5 transgenic and knockout animals; apoC3 levels were increased ˜90% in apoA5 knockouts and decreased ˜40% in apoA5 transgenics. These data suggest that apoC3 may exert its effect on triglyceride levels by altering apoA5 levels.

Because alterations in apoA5 expression lead to changes in apoC3 protein levels, the effect on triglycerides may be mediated through apoC3. The fact that apoA5 transgenic mice have two-fold lower triglycerides than the previously described apoC3 knockout mice indicate that changes in apoC3 alone can not explain the entire effect of apoA5. In addition to APOC3, the over-expression of several human apolipoprotein transgenes has been shown to increase triglyceride levels in mice, while only the APOAV transgene leads to decreased triglycerides suggesting a novel mechanism behind this effect.

While not being bound to one theory, the inventors theorize that the APOAV gene product (protein) interacts with other proteins in the apo family (e.g. APOC3) in such a way as to affect their levels, and thereby triglyceride levels. The inventors describe a direct correlation between APOAV and APOC3. Thus, this embodiment also provides non-human animals to explore the regulation and expression of apoA5 and apoC3, the interaction between these two apolipoproteins and other apolipoproteins, and further in vivo study of APOC3. APOC3 is known to inhibit triglyceride lipolysis on VLDL, thus contributing to higher levels of plasma triglyceride and VLDL. The transgenic mice over-expressing human APOAV showed a decrease in APOC3 levels thereby suggesting a mechanism behind APOAV's effect on plasma triglyceride levels. Furthermore, mice lacking APOAV have increased APOC3 levels.

Therefore, the preferred embodiment includes a method for determining predisposition towards elevated triglyceride levels of an individual, comprising determining the level of APOAV gene expression, wherein elevated APOAV gene expression is associated with decreased elevated triglycerides and lowered APOAV gene expression is associated with increased elevated triglycerides. The method further comprising determining the level of APOC3 gene expression, wherein lowered APOC3 gene expression is associated with decreased elevated triglycerides and elevated APOC3 gene expression is associated with increased elevated triglycerides.

F. APOAV Haplotypes and Frequencies

The population frequency for each haplotype is the percentage of individuals who have a given haplotype. Statistically, approximately 50-75% of the population is homozygous for the common haplotype (*1/*1) that is correlated with lower triglyceride levels, while approximately 25-50% of the population contains at least one copy of the minor haplotypes (APOA5*2 and/or APOA5*3) which is correlated with increased triglyceride levels. In addition, approximately 0.6-1.5% of the population is homozygous with both chromosomes containing the rare haplotypes (*2/*2, *3/*3 or *2/*3), which is correlated with the highest triglyceride levels.

Association studies that were conducted indicate the existence of three haplotypes in APOAV present in the human population, which are associated with plasma triglyceride levels. Preliminary studies in this population found no significant association of triglyceride levels with the Sst1 polymorphism in APOC3 (located ˜40 kbp upstream of APOAV) (FIG. 1A) which has been previously associated with severe hyper-triglyceridemia (M. R. Hayden, et al., Am J Hum Genet 40, 421-30 (1987); M. Dammerman, L. A. Sandkuijl, J. L. Halaas, W. Chung, J. L. Breslow, Proc Natl Acad Sci USA 90, 4562-6 (1993). This finding suggests the APOC3 Sst1 polymorphism is not a marker for the metabolic effect defined by the APOAV haplotypes.

The three haplotypes (APOA5*1, APOA5*2, APOA5*3) are composed of biallelic markers at the following positions on APOAV: −1131T>C (SNP3), c.−3A>G (SNP6), c.56C>G (SNP5), IVS3+476G>A (SNP2) and c.1259>C (SNP1). Table 2 shows the three haplotypes and the relative frequencies that each appears in the Caucasian general population.

TABLE 2 −1131T > C c.−3A > G c.56C > G IVS3 + 476G > A c.1259T > C Haplotype Frequency (SNP3) (SNP6) (SNP5) (SNP2) (SNP1) APOA5*1 81.6% T A C G T APOA5*2 8.0% C G C A C APOA5*3 8.0% T A G G T

The frequency listed for each haplotype is the relative frequency per chromosome, meaning that statistically, approximately 75% of the Caucasian population is homozygous for the common haplotype (*1/*1) that is correlated to low triglyceride levels, approximately 25% of the Caucasian population is heterozygous with one chromosome having the common haplotype and the other containing a rare haplotype (APOA5*2 or APOA5*3) which is correlated to raised triglyceride levels and approximately 0.6% or less than 1 percent of the population is homozygous with both chromosomes containing the rare haplotypes (*2/*2, *3/*3 or *2/*3), which correlates to the highest triglyceride levels. In addition to APOAV's strong association with triglyceride levels in Caucasians, a strong effect is also seen African-Americans and Hispanics where the minor allele frequencies are higher. Thus, a larger percent of African-Americans and Hispanics display increased triglycerides due to the genetic effect of APOAV. Specifically, APOA5*2 and/or APOA5*3 is present in 36% of African Americans and 51% of Hispanics and results in an ˜25% increase in triglycerides compared to APOA5*1 homozygotes.

Thus, the preferred embodiment includes a method of determining an individual's total risk of lipid-related diseases or disorders by identifying an individual's APOAV haplotype on each chromosome. One needs only genotype individuals at two different polymorphic loci, wherein one of those loci is SNP5, to determine which haplotypes the individual possesses, and whether the individual is heterozygous or homozygous for the rare or normal alleles (defining APOA5*3). The haplotypes can be easily determined by detecting the genotype of individuals at SNPs 1-3 or 6 (APOA5*2) and at SNP5 (APOA5*3) for both copies of chromosome 11. Based on the knowledge of what haplotypes the individual possesses, the amount of risk for lipid-related diseases or disorders can then be determined or predicted. For example, if the individual is genotyped and found to have a T at SNP3 on one chromosome and a C at SNP3 on the other chromosome, then it can be determined that the individual is heterozygous, having APOA5*2 haplotype on one of the chromosomes. Then genotyping the individual at SNP5 will distinguish whether the other chromosome is a rare haplotype (APOA5*3) or the normal haplotype (APOA5*1). Methods of detecting SNPs and genotyping are discussed in the Diagnostic Applications section.

G. Diagnostic Applications

The present embodiment enables genetic testing for APOAV and its correlation to increased triglyceride levels in people having polymorphisms deviating from the normal or “wild type” phenotype. Further, a combination test with APOC3 is suggested. Genetic testing may be carried out on a patient's DNA or RNA or protein, provided that antibodies capable of distinguishing mutant from wild type APOAV protein are available.

1. Antibodies to APOAV and its Variants

Antibodies including both polyclonal and monoclonal antibodies, and drugs that modulate the production of activity of APOAV possess certain diagnostic applications and may, for example, be utilized for the purpose of detecting the identity of the haplotype of individuals. For example, wild type APOAV and its variants may be used to produce both polyclonal and monoclonal antibodies in a variety of cellular media, by known techniques such as the hybridoma technique utilizing, for example, fused mouse spleen lymphocytes and myeloma cells. Likewise small molecules that mimic or agonize the activity(ies) of APOAV may be discovered or synthesized, and may be used in diagnostic and/or therapeutic protocols.

The general methodology for making monoclonal antibodies by hybridomas is well known. Immortal, antibody-producing cell lines can be created by techniques other than fusion, such as direct transformation of B lymphocytes with oncogenic DNA, or transfection with Epstein-Barr virus. See, e.g., M. Schreier et al., “Hybridoma Techniques” (1980); Hammerling et al., “Monoclonal Antibodies And T-cell Hybridomas” (1981); Kennett et al., “Monoclonal Antibodies” (1980); see also U.S. Pat. Nos. 4,341,761; 4,399,121; 4,427,783; 4,444,887; 4,451,570; 4,466,917; 4,472,500; 4,491,632; 4,493,890.

Panels of monoclonal antibodies produced against APOAV peptides can be screened for various properties; i.e., isotype, epitope, affinity, etc. Of particular interest are monoclonal antibodies that specifically bind and identify the alleles of APOAV, and can distinguish between the rare and the normal alleles of APOAV. In one preferred embodiment, a monoclonal antibody can be generated that specifically binds to the W19 position of the APOAV protein, which results from the rare SNP5 allele. Such monoclonals can be readily identified in, for example, gel-shift assays. High affinity antibodies are also useful when immunoaffinity purification of native or recombinant APOAV is possible.

A preferred method of generating these APOAV allele-specific antibodies is by first synthesizing peptide fragments. These peptide fragments should cover at least SNP5 and the adjacent amino acid sequence. Subsequent antibodies should be screened for their ability to distinguish the two protein variants. Since synthesized peptides are not always immunogenic on their own, the APOAV peptides should be conjugated to a carrier protein before use. Appropriate carrier proteins include but are not limited to Keyhole limpet hemacyanin (KLH). The conjugated peptides should then be mixed with adjuvant and injected into a mammal, preferably a rabbit through intradermal injection, to elicit an immunogenic response. Samples of serum can be collected and tested by ELISA assay to determine the titer of the antibodies and then harvested.

Polyclonal APOAV allele-specific antibodies can be purified by passing the harvested antibodies through an affinity column. Monoclonal antibodies are preferred over polyclonal antibodies and can be generated according to standard methods known in the art of creating an immortal cell line which expresses the antibody.

Additionally, spleen cells can be harvested from the immunized animal (typically rat or mouse) and fused to myeloma cells to produce a bank of monoclonal antibody-secreting hybridoma cells. The bank of hybridomas can be screened for clones that secrete immunoglobulins that bind the protein of interest specifically, i.e., with an affinity of at least 1×10⁷ M⁻¹. Animals other than mice and rats may be used to raise antibodies; for example, goats, rabbits, sheep, and chickens may also be employed to raise antibodies reactive with an APOAV protein. Transgenic mice having the capacity to produce substantially human antibodies also may be immunized and used for a source of antiserum and/or for making monoclonal antibody secreting hybridomas.

Bacteriophage antibody display libraries may also be screened for phage able to bind peptides and proteins specifically. Combinatorial libraries of antibodies have been generated in bacteriophage lambda expression systems and may be screened as bacteriophage plaques or as colonies of lysogens. For general methods to prepare antibodies, see Antibodies: A Laboratory Manual (1988), E. Harlow and D. Lane, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y., incorporated herein by reference.

These antibodies can in turn be used to isolate APOAV proteins from normal or recombinant cells and so can be used to purify the proteins as well as other proteins associated therewith. Such antibodies are useful in the detection of specific alleles of APOAV proteins in samples and in the detection of cells comprising APOAV proteins in complex mixtures of cells. Such detection methods have application in screening, diagnosing, and monitoring lipid metabolism related diseases and other conditions, such as high levels of triglycerides.

2. Genotyping and Haplotyping

Any method known in the art can be used to identify the nucleotide present at one of the disclosed APOA5 polymorphic sites. Since the SNPs and haplotypes to be detected have been identified and specified in the present invention, detection will prove simple for one of ordinary skill in the art. Any number of techniques to detect the haplotype of an individual by genotyping the individual at certain polymorphic sites can be used, including, but not limited to, the following.

The nucleotide can be determined by sequencing analysis after DNA samples are subjected to PCR amplification. Preferably, the amplified DNA is subjected to automated dideoxy terminator sequencing reactions using a dye-primer cycle sequencing protocol. The sequencing reactions are then sequenced using any number of commercially available sequencing machines such as the ABI 377 or 3700 Sequence Analyzer (Applied Biosystems, Foster City, Calif.).

Techniques and methods of synthesizing and amplifying polynucleotides by litigation of multiple oligomers (LMO) onto a template-bound primer are also described by Akhavan-Tafti in U.S. Pat. Nos. 5,998,175; 6,001,614; 6,013,456; and 6,020,138, which are hereby incorporated by reference in their entirety. Short polynucleotides, 5 to 10 bases long, can be supplied as a library of oligonucleotides and are simultaneously ligated, using a suitable ligase enzyme, to a template-bound primer in a contiguous manner to produce a complementary strand of template polynucleotide. If the sequence to be synthesized is known, a set containing the minimum number of oligomers can be used and are then ligated by DNA Ligase in the correct order starting from the primer, uni- or bi-directionally, to produce the complementary strand of a single-stranded template sequence.

A preferred method is to use sequence detection/amplification assays such as the INVADER assays which are commercially available from Third Wave Technologies (Madison, Wis.) to genotype samples. Such systems rely on an enzyme-substrate reaction to amplify signal generated when a perfect match with an (rare) allele of APOAV is detected. See Dahlberg, J. et al., U.S. Pat. Nos. 5,846,717 and 5,888,780, which are hereby incorporated by reference in their entity.

A third preferred method is using methods that have been developed for examining single base changes without direct sequencing. For example, if a mutation of interest happens to fall within a restriction recognition sequence, a change in the pattern of digestion can be used as a diagnostic tool (e.g., restriction fragment length polymorphism [RFLP] analysis) See U.S. Pat. Nos. 5,547,835; 6,221,601; 6,194,144 which are hereby incorporated by reference in their entirety. Other methods of SNP analysis are performed by companies such as Sequenom (San Diego, Calif.), which can genotype many samples very quickly and with great accuracy, non-sequencing methods such as MALDI-TOF, miniaturized chip-based array formats and mass spectrometry.

Other genotyping methods suited for detection of SNPs include, but are in no way limited to, LCR (ligase chain reaction), Gap LCR (GLCR), using allele-specific primers, mismatch detection assays, microsequencing assays, and hybridization assay methods.

3. Oligonucleotide Primers and Probes

Various methods for screening for genetic APOAV abnormalities in individuals can be employed. Polynucleotides according to SEQ ID NOs: 1-3 and 5-7 can also be used in gene marker assays, probes, primers for uses including, but not limited to, PCR, sequencing, hybridization assays and probes. Variations that are at least 95% or more homologous to the sequences of APOAV polynucleotides (e.g. SEQ ID NOs: 1-3, 5 and 6) may also be used for comparison studies and in any of the above listed types of assays. In another embodiment, polypeptides that are at least 95% of more homologous to APOAV protein (e.g. SEQ ID NO: 4) or to the protein generated from polynucleotide sequences selected from the group consisting of SEQ ID NO: 1-3, 5-6 may be used for lipid studies.

The preferred embodiment also encompasses APOAV oligonucleotide primers made from SEQ ID NO: 3 and 4 and capable of amplifying the DNA sequence of and surrounding each of SNPs 1-6. Basic primer design considerations such as annealing/melting temperature, length, repetitive DNA, proximity to the SNP, and specificity will be appreciated and addressed by one skilled in the art. Many programs that enable one to pick and design custom primers address these considerations, such as PRIMER3 (S. Rozen and H. J. Skaletsky).

Suitable primers such as those disclosed in Table 3, SEQ ID NOs: 8-36 and primers made from sequence up to about 500 base pairs away from the SNP can be used for amplification, may be used to assay SNP5 (position 12974). and/or sequencing these SNPs. For example, SEQ ID NO: 24 (AV1-F 5′ TGCTCACCTGGGCTCTGGCTCTTC) and SEQ ID NO: 25 (AV1-R 5′ CCAGAAGCCTTTCCGTGCCTGGGCGGC) which lie in SEQ ID NO: 3 and 4 at positions 12824-12847 and 12976-13002 respectively Furthermore, depending upon the genotyping strategy used, other probes and primers can be designed from SEQ ID NOs: 1-6 for use in such assays as PCR-RFLP and PCR INVADER assays (Third Wave Technologies, Madison, Wis.).

The following table shows primers that can be used to amplify genomic DNA surrounding SNPs 1-6 by such methods as PCR. The examples of forward and reverse primers that can also be used to amplify sequence containing each of the described SNPs 1-6. The resulting amplified product can be genotyped by methods including, but not limited to, sequencing, mass spectrometry, RFLP, and INVADER assays. Primers such as those disclosed in Table 3, SEQ ID NOS: 8-36 and primers made from sequence up to about 500 base pairs away from the SNP can be used for amplification and/or sequencing these SNPs. For example, SEQ ID NO: 24 (AV1-F 5′ TGCTCACCTGGGCTCTGGCTCTTC) and SEQ ID NO: 25 (AV1-R 5′ CCAGAAGCCTTTCCGTGCCTGGGCGGC

TABLE 3 SEQ Length of ApoA5 ID Position on amplified SNP NO Primer Sequence ApoA5 gene sequence ApoA5- 39 ATGACCTGTGGGAAGACATCACT Forward 14470-14492 455 bp SNP1 40 AGCCAGAAGTGACTAGAGCCAAA Reverse 14902-14924 ApoA5- 41 AGTCCCCAGAATCAAAGGATGAT Forward 13341-13363 497 bp SNP2 42 ATCGTGTAGGGCTTCAGTTGCT Reverse 13816-13837 ApoA5- 43 CCTGTCTTCTCAGAGCAGGTAATG Forward 12784-12807 285 bp SNP5 44 AGCCATCTTCTGCTGATGGATCT Reverse 13046-13068 ApoA5- 45 AAGACACCCTAGCCTCCTTGACT Forward 12602-12624 566 bp SNP3 + 46 ACAGAGGTTGAGGCAGCAGAG Reverse 13147-13167 SNP6 ApoA5- 47 GTAGTGAAAATCAGGGGCCTTCT Forward 484-506 158 bp SNP4 48 ATGCATAAACCCAAAGGGAAAAT Reverse 619-641

In one embodiment of the invention, fragments of various lengths of APOAV DNA may be placed onto solid supports for use in gene chips or other parallel formats for assay purposes. In general, these methods employ arrays of oligonucleotide probes that are complementary to targeted nucleic acid sequences, and allow for detection when the sample hybridizes to a probe on the array. In preferred embodiments, the nucleic acid sequences are APOAV fragments of about 15-30 nucleotides in length, specifically sequences containing APOAV SNPs 1-6. In further embodiments, the chip may comprise an array including at least one of the sequences selected from the group consisting of amplification primers listed in Tables 3 and 4. See D. J. Lockhart, et al., “Expression monitoring by hybridization to high-density oligonucleotide arrays,” Nature Biotechnology, 14:1675-1680, December 1996, for useful methods and heuristics in designing oligonucleotide probes from APOAV fragments.

Chips of various formats from companies such as Agilent Technologies (Palo Alto, Calif.) and Affymetrix (Santa Clara, Calif.) can be produced on a customized basis by various methods. Alternatively, DNA microarray chips are fairly inexpensive to make and assemble. Individual samples to be tested are then contacted with the oligonucleotide probes and the genotype and/or haplotype of the sample can be determined based on detection of the hybridization between the probes and the sample. A suitable DNA micro-array is disclosed in Brown et al. U.S. Pat. No. 5,807,522

H. Modulating and Regulating, APOAV Expression

The preferred embodiment also encompasses methods of modulating and regulating APOAV expression. Current therapies known to effect lipid metabolism can also be studied for their effect in modulating and regulating APOAV expression. Current methods include but are not limited to, administration of fibrates and other molecules important in inflammatory response, cholesterol regulating drugs, and glucose and insulin regulatory molecules.

For example, fibrates are hypolipidemic drugs with pleiotropic effects on lipid metabolism including the reduction of plasma triglycerides. Suitable fibrate drugs are disclosed in U.S. Pat. No. 4,318,923 issued to Hamayaki et al. And hereby incorporated by reference. Classically, the triglyceride lowering action of fibrates is explained by decreased hepatic secretion of VLDL and an enhancement in plasma triglyceride clearance. Several studies established that this effect is mediated through the induction of lipoprotein lipase expression and down-regulation of APOC3 expression by fibrates. A major means by which fibrates regulate the expression of lipid metabolism-related genes by fibrates has been shown to be via activation of the peroxisome proliferator-activated receptor alpha (PPARα). Three distinct PPARs (α, β, and γ) have been described in different species. Whereas PPARβ appears ubiquitously expressed, PPARα and PPARγ are mainly expressed in liver and in adipose tissue, respectively. PPARs are ligand-activated nuclear receptors that dimerize with the retinoid X receptor (RXR) and bind to specific DNA sequence defined as peroxisome proliferator response elements (PPRE). Upon binding, PPARs activate gene transcription.

Given the determinant link between APOAV and plasma triglycerides and the widespread use of fibrates in the treatment of dyslipidemia, one could investigate how fibrates affect APOAV gene expression and consequently influence plasma triglyceride levels. It is very likely that studies in mice and in vitro studies with human hepatocytes reveal that fibrates dramatically increase APOAV expression.

To determine if fibrates effect on apoa5 is mediated via the PPARα pathway, sequence conservation comparison, in vitro promoter analyses and functional studies of putative PPREs to the APOAV gene can be performed. These and other studies may identify fibrates acting via PPARα as a crucial regulator of the new apolipoprotein APOAV and suggest a novel and likely clinically relevant mechanism of how PPARα activators can act on lipid homeostasis. Modulation of APOAV via a PPARα pathway would prove to offer a new target for therapeutic interventions designed at correcting hypertriglyceridemia and at limiting triglyceride-associated cardiovascular risk.

A. I. Drug Design and Therapies Based on Sequence Variations B. 1. Drug Screening and Design

In addition to modulating the expression of the APOAV gene, the present embodiment further contemplates an alternative method for identifying specific agonists and activators using various screening assays known in the art.

The preferred embodiment contemplates screens for small molecule ligands or ligand analogs and mimics, as well as screens for natural ligands that bind to and agonize APOAV activity in vivo or result in lowered levels of triglycerides. For example, natural products libraries can be screened using assays of the invention for molecules that agonize APOAV activity. Knowledge of the primary sequence of the various APOAV allele variants and other structural motifs of APOAV (i.e., amphipathic α-helices), and the similarity of those sequences with domains contained in other proteins, can provide an initial clue to agonists of the protein. Identification and screening of agonists is further facilitated by determining structural features of the protein, e.g., using X-ray crystallography, neutron diffraction, nuclear magnetic resonance spectrometry, and other techniques for structure determination. These techniques provide for the rational design or identification of agonists of APOAV that will reduce triglyceride levels.

Another approach uses recombinant bacteriophage to produce large libraries. Using the “phage method” Scott and Smith, 1990, Science 249: 386-390 (1990); Cwirla, et al., Proc. Nat. Acad. Sci., 87: 6378-6382 (1990); Devlin et al., Science, 249: 404-406 (1990), very large libraries can be constructed. A second approach uses primarily chemical methods, of which the Geysen method, Geysen et al., Molecular Immunology 23: 709-715 (1986); Geysen et al. J. Immunologic Method 102: 259-274 (1987), and the method of Fodor et al. Science 251: 767-773 (1991) are examples. Houghton in U.S. Pat. No. 4,631,211, and Rutter et al., U.S. Pat. No. 5,010,175, describe methods to produce a mixture of peptides that can be tested as agonists or antagonists.

In another aspect, synthetic libraries and the like can be used to screen for ligands that recognize and specifically bind to APOAV and its variants. In one such example, a phage library can be employed. Phage libraries have been constructed which when infected into host E. coli produce random peptide sequences of approximately 10 to 15 amino acids, Parmley and Smith, Gene, 73: 305-318 (1988), Scott and Smith, Science, 249: 386-249 (1990). Specifically, the phage library can be mixed in low dilutions with permissive E. coli in low melting point LB agar which is then poured on top of LB agar plates. After incubating the plates at 37° C. for a period of time, small clear plaques in a lawn of E. coli will form which represents active phage growth and lysis of the E. coli. A representative of these phages can be absorbed to nylon filters by placing dry filters onto the agar plates. The filters can be marked for orientation, removed, and placed in washing solutions to block any remaining absorbent sites. The filters can then be placed in a solution containing, for example, a radioactive fragment of APOAV. After a specified incubation period, the filters can be thoroughly washed and developed for autoradiography.

Plaques containing the phage that bind to the radioactive binding domain can then be identified. These phages can be further cloned and then retested for the ability to bind to APOAV and/or its variants. Once the phages have been purified, the binding sequence contained within the phage can be determined by standard DNA sequencing techniques. Once the DNA sequence is known, synthetic peptides can be generated which represent these sequences.

The effective peptide(s) can be synthesized in large quantities for use in in vivo models and eventually in humans to reduce triglyceride levels. Synthetic peptide production is relatively non-labor intensive, easily manufactured, quality controlled and thus, large quantities of the desired product can be produced quite cheaply. Similar combinations of mass produced synthetic peptides have recently been used with great success. Patarroyo, Vaccine, 10: 175-178 (1990). The peptides may be prepared according to known pharmaceutical technology. They may be administered singly or in combination, and may further be administered in combination with other cardiovascular drugs. They may be conventionally prepared with excipients and stabilizers in sterilized, lyophilized powdered form for injection, or prepared with stabilizers and peptidase inhibitors of oral and gastrointestinal metabolism for oral administration.

Another embodiment is to create a cell system which has the 5′ regulatory region of the human APOAV gene coupled to a reporter gene, such as luciferase, as is known in the art. The luciferase gene is positioned at the start of the APOAV gene. Candidate drugs are screened against the cell system and scored for their ability to upregulate the luciferase expression. These drugs will have use in lowering plasma triglycerides, according to the findings of the inventors that increased levels of the APOAV protein cause lowered plasma triglycerides as shown by Example 3.

Other high-throughput methods of drug design and discovery are discussed in Landro, J. A. et al., “HTS in the new millennium, the role of pharmacology and flexibility,” J Pharmacol Toxicol Methods, 2000 July-August; 44(1):273-89, describing target identification, reagent preparation, compound management, assay development, high-throughput library screening and other methods for drug discovery and screening, and is hereby incorporated by reference in its entirety.

While lowering triglyceride levels is an aim of the preferred embodiment, other embodiments target other metabolite levels such as insulin or glucose levels, by modulating APOAV gene expression. As show in Example 9, APOAV levels can lead to changes in plasma glucose or insulin levels or other metabolite levels. Therefore, alternate embodiments contemplate the aforementioned methods of drug screening and drug design for the purpose of modulating APOAV to affect other metabolite levels.

2. Gene Therapy with APOAV

The preferred embodiment also encompasses uses of the APOAV gene for gene therapeutics such as those described by Gabor M. Rubanyi, “The future of gene therapy,” Molecular Aspects of Medicine 22(2001): 113-142, and is hereby incorporated by reference in its entirety. Rubanyi describes existing and future methods of gene therapy and the technical hurdles gene therapy faces in the future are made possible through the sequences disclosed in SEQ ID NO: 1-7. Other examples are drug therapies aimed at raising the levels of APOAV in any human patient with high triglyceride levels. These will provide a suitable way to reduce triglyceride levels and thereby reduce the risk of cardiovascular disease. Further aims include determining how APOAV exerts its effect upon triglyceride and other metabolite levels and to stimulate that pathway by non-APOAV means as a way to lower triglycerides or modulate other metabolite levels.

As described in an earlier section, various types of gene delivery vectors can be used including, but definitely not limited to, plasmids, YACs (Yeast Artificial Chromosomes), BACs (Bacterial Artificial Chromosomes), bacterial vectors, bacteriophage vectors, viral vectors (for example, retroviruses, adenoviruses and viruses commonly used for gene therapy), non-viral synthetic vectors, and recombinant vectors. Delivery of the vector and/or construct for gene therapy in a preferred embodiment is by viral infection or injection intravenously although delivery can be by any other means as described previously.

A preferred embodiment is modelled after the method described by Tangirala R K et al., Circulation, 1999 Oct. 26; 100(17):1816-22, wherein the regression of atherosclerosis was induced by liver-directed gene transfer of apolipoprotein A-I in mice. The preferred embodiment contemplates a similar protocol of gene transfer as Tangirala et al. based on the same target tissue and the desire to express APOAV endogenously in the liver. A second-generation recombinant adenovirus encoding SEQ ID NO: 1 or 2, human APOAV cDNA can be constructed as described by Tsukamoto K. et al., Journal of Lipid Research, 1997:38, 1869-1876. Briefly, pAdCMV APOAV can be linearized with an enzyme and co-transfected into cells along with adenoviral DNA isolated and digested. The cells are then overlaid with agar and incubated at 32° C. for about 15 days. Plaques positive for APOAV cDNA are subjected to a second round of plaque purification, and the recombinant adenovirus is then expanded in cells at 32° C. A null adenovirus can be constructed and expanded in an identical manner. All viruses are then purified and stored appropriately.

While much of gene therapy uses vectors as a means of delivery, other methods of delivery to the somatic cells of a patient may be utilized. The preferred embodiment also contemplates the delivery of APOAV polynucleotides by encapsulation by compositions such as, hydrogels and microgels, liposomes, and other lipid or polymer carriers. Furthermore, the APOAV polynucleotides can be delivered naked, without any means of receptor-mediated entry or other carrier into the patient's cells.

3. Therapeutics Using APOAV

The presently disclosed APOAV polynucleotides and polypeptides, and fragments thereof, may be prepared according to known pharmaceutical technology. They may be administered singly or in combination, and may further be administered in combination with other cardiovascular or triglyceride-lowering drugs. They may be conventionally prepared with excipients and stabilizers in sterilized, lyophilized powdered form for injection, or prepared with stabilizers and peptidase inhibitors of oral and gastrointestinal metabolism for oral administration. They may also be administered by methods including, but not limited to, intravenous, infusion, rectal, inhalation, transmuscosal or intramuscular administration.

The APOAV polynucleotides and polypeptides can be isolated, recombinant or synthesized, so long as the polynucleotides and polypeptides maintain APOAV functionality. In a preferred embodiment, the APOAV polynucleotide of SEQ ID NO: 1-3 or 5 is delivered in the therapy whereby the APOAV gene is over expressed in the organism. In other preferred embodiments, the polypeptide or active APOAV protein of SEQ ID NO: 4 is delivered to lower triglyceride levels.

Combining data from stratification and genetic studies with diagnostic tests to determine the best method of treatment for person based upon such criteria as specific haplotype, age, gender and ethnicity. For example, after finding in a genetic study that individuals having haplotypes APOA5*1/*2 and a specified triglyceride level, respond to a certain dosage of fibrates (e.g. their triglyceride levels dramatically are reduced by an average 50 dl/mL), physicians and medical providers can tailor triglyceride therapy to prescribe the most effect dosage of triglyceride lowering medication. After ordering the diagnostic tests described earlier for individuals to determine what haplotype they possess, doctors and other medical providers can then prescribe the most effective dosage to achieve the goal of dramatically reducing triglycerides to persons having the haplotypes of APOA5*1/*2. In other embodiments, the sample of individuals can be broken down according to other criteria, including, but not limited to, age, gender, ethnicity, diet or the presence or absence of certain disease symptoms.

J. Methods of Genetic Analysis and Association Studies

In general, the SNPs of this invention find use in any method known in the art to demonstrate a statistically significant correlation between a genotype and phenotype, and between a haplotype and phenotype. Preferably, the SNPs are used in studies to determine their correlation to lipid metabolism disorders. More preferably, the SNPs are used in studies to determine whether they are causative mutations of lipid metabolism disorders.

The described polymorphisms can be used to separate individuals based on any phenotypic trait. For instance, patients can be treated with fibrates and their triglyceride levels can be determined. Individuals can then be separated based on their APOAV genotype/haplotype (APOA5*1, APOA5*2, or APOA5*3) and their average triglyceride level determined. This will enable a physician to address if APOAV polymorphisms influence how responsive an individual will be to a triglyceride therapy.

A similar strategy could be used for any drug therapy. As another example, a certain diseased group of individuals could be separated based on their APOAV genotype/halotype, and all the average phenotypes from these groups can be examined for differences. If any phenotype display shows a difference, this would be a phenotype that APOAV may influence. For instance, a group of diabetics could be separated based on their APOAV genotype. Numerous phenotypes in these subgroups can be averaged and compared, such as glucose levels. If there is a difference in glucose levels, this would support the proposal that APOAV influences glucose levels in diabetes. Another example would be to look at every type of cardiovascular disease and see if there is an increased frequency of the minor haplotypes in the diseased group compared to controls. If there is a difference then APOAV likely contributes to this disease.

Criteria or methods for selecting individuals for treatments, drug trials and any of the studies described herein include, but are not limited to, such criteria for eligibility as: willingness to participate in program, no medication use likely to interfere with lipid metabolism, percentage of ideal body weights according to such tables and indices available such as Metropolitan Life Insurance Company Tables (1985), certain body mass index, free of chronic disease, nonsmoker, daily alcohol consumption, related or unrelated to other subjects in the study, family and other relatives living and willing to donate blood samples or submit to studies, belonging to certain age and/or ethnicity groups, possessing defined levels of plasma total cholesterol, triacylglycerols and blood pressure, adherence to diet and/or exercise protocol and requirements, and any other measurable genotypic or phenotypic trait. In addition to meeting this criteria, analysis of the plasma lipids, lipoproteins, lipoprotein subfractions; triglycerides and apolipoproteins of the subjects should be done to develop complete profiles of each subject.

For more examples of preferred subject criteria and methods of measuring triglycerides, lipoproteins, cholesterol, and other related lipid metabolism proteins and methods for conducting clinical trials as herein described, see D. Dreon et al., Arteriosclerosis, Thrombosis, and Vascular Biology. 1997; 17:707-714; D. Dreon et al., Am J Clin Nutr. 1998; 67:828-36; and Williams et al., Arteriosclerosis, Thrombosis, and Vascular Biology. 1997; 17:702-706, which are hereby incorporated by reference in their entirety.

The preferred embodiment permits genetic analysis studies between the disclosed SNPs 1-6, the APOAV haplotypes (APOA5*1/*2/*3) and any phenotype. In general, the SNPs and haplotypes of the present invention find use in any method known in the art to demonstrate a statistically significant correlation between a genotype and phenotype. The genetic analysis using the SNPs and haplotypes that may be conducted include but are not limited to linkage analysis, population association studies, allele frequencies, haplotype frequencies, and linkage disequilibrium.

Linkage analysis is based upon establishing a correlation between the transmission of genetic markers and that of a specific trait throughout generation within a family. Thus, the aim of linkage analysis is to detect marker loci that show co-segregation with a trait of interest. Linkage analysis correlating APOAV SNPs and haplotypes and the trait of high triglyceride levels within families or people/ethnic groups are an aim of this invention. The examples demonstrate linkage analysis studies that correlated the presence of either APOA5*2 or APOA5*3 with raised triglyceride levels in the Caucasian, African-American and Hispanic populations. Further linkage analysis is also contemplated for studies of other people and ethnic groups, and further regional studies including groups in other countries. Linkage analysis can be performed according to parametric or non-parametric methods.

Frequency of alleles and haplotypes in a population is also another genetic analysis study contemplated by the invention. Using the genotyping and haplotyping methods described in the earlier “Genotyping and Haplotyping” section, one skilled in the art can determine the frequency of SNPs 1-6 and haplotypes APOA5*1/*2/*3 in a given population. While several methods of estimating allele frequency are possible, genotyping individual samples is preferred over genotyping pooled samples due to higher sensitivity, reproducibility and accuracy. Furthermore, many genomic and large-scale sequencing centers enable rapid genotyping and haplotyping by sequencing methods and thereby provide rapid data production.

Association studies between APOAV SNPs and haplotypes and any phenotype can also be performed on a random sample of people, anywhere from a few hundred to tens of thousands. After collecting various parameters for each individual participating the study, such as height, weight, triglyceride levels, medical history, etc., the sample group can be separated according to various genotypes at APOAV. Any repeated differences in the parameters in individuals that are observed are likely traits that are associated with one of the APOAV genotypes or haplotypes. Examples show that there are differences in triglyceride levels that are associated with APOAV haplotypes *1, *2 and *3, however, there are likely other associations that can be subject to study. Other parameters to observe include, but are not limited, presence of cardiovascular disease risks, other lipid, lipoprotein or protein levels, instances of diabetes, obesity, inflammatory diseases, inflammatory response, apolipoprotein expression levels, alcoholism and drug abuse.

Alternate embodiments also encompass a method of determining if SNPs 1-6 are in linkage disequilibrium with any lipid-related or other disorders.

Studies correlating the genotype/haplotype with methods and treatments of high triglycerides or other lipid-related disorder are also contemplated. Segregation of individuals in the study according to their response (e.g. lowering of triglyceride levels) to various drug therapies and combinations and then according to the APOAV allele frequency. The result of stratification of population studies would enable doctors and medical care providers to prescribe therapy with greater accuracy, and with greater success rates. Thus, therapy prescribed would be “tailor-made” for individuals based upon their haplotypes.

Statistical methods and computer programs useful for linkage analysis, genetic analysis and association studies are well-known to those skilled in the art. Any statistical tool useful to test for statistically significant associations between genotypes, haplotypes and phenotypes, comparisons and correlations between a biological marker and any physical trait, and frequency comparisons may be used.

Statistical analyses can be carried out using the SAS computer program (SAS, Cary, N.C.) and similar programs. Plasma triglyceride concentrations can be compared among different genotype groups using Wilcoxon's test and the like. Allele frequencies should be compared using such tests as Fisher's exact test. To determine pairwise linkage disequilibrium (LD) between SNPs, haplotype frequencies, estimations can be done using the Expectation-Maximization (EM) algorithm implemented in the computer program ARLEQUIN v. 2.0 ((Excoffier and Slatkin, Mol. Biol. Evol. 1995, 12 (5):921-927), and downloadable from http://lgb.unige.ch/arlequin/), an exploratory population genetics software environment.

Pair-wise measure of linkage disequilibrium (|D′|) can be calculated for all combinations of frequencies as described by R. C. Lewontin, Genetics 120, 849-52 (1988). A |D′| value of 1 indicates complete linkage disequilibrium between two markers.

Examples of useful statistical methods and techniques include Analysis of Variance (ANOVA), Fischer's test for pair-wise comparison and Wilcox's test, generally carried out using programs such as SPSS (Chicago, Ill.), STATVIEW and SAS (both available from SAS, Cary, N.C.).

EXAMPLE 1

Identifying and Isolating APOAV

Orthologous mouse genomic DNA was isolated from a pooled BAC library using the polymerase chain reaction (PCR) with mouse primers: apoAI-F1-5′-GAGGATGTGGAGCTCTACCGC-3′ (SEQ ID NO:8) and apoAI-R1-5′-CTGTGTGCGCAGAGAGTCTACG-3′) (SEQ ID NO:9) (RPCI-23, BACPAC Resources, Children's Hospital Oakland Research Institute; (See K. Osoegawa, et al., Genome Res 10, 116-28 (2000)). Positive clone RPCI-23-175F2 was identified, randomly sheared, sub-cloned and sequenced to approximately six-fold coverage according to methods described by I. Dubchak, et al., Genome Res 10, 1304-6 (2000) and G. G. Loots, et al., Science 288, 136-40 (2000). The sequence was deposited in GenBank (GenBank accession number AF401201). Human and mouse sequence comparisons were performed as previously described. Protein analyses were performed using the web-based Predict-Protein package, COILS (A. Lupas, et al., Science 252, 1162-4 (1991).), and SignalP (H. Nielsen, et al., Protein Eng 10, 1-6 (1997)).

The VISTA (www-gsd.lbl.gov/vista) graphical plot in FIG. 1B displays the level of homology between human and the orthologous mouse sequence spanning the apoAI/CIII/AIV cluster. Human sequence is represented on the x-axis and the percent similarity with the mouse sequence is plotted on the y-axis (ranging from 50-100% identity). Once the mouse sequence had been generated and the comparison obtained, a relatively high level of homology was observed in the region of the present APOAV, as can be seen from the plot.

To identify expression patterns of APOAV, mice were sacrificed and tissues harvested for either total RNA isolation using the RNA easy-midi protocol (Qiagen, Valencia, Calif.) or for polyA mRNA isolation using the FastTrack 2.0 system (Invitrogen, Carlsbad, Calif.). Approximately 10 μg of total RNA or 2 μg of polyA MRNA were separated in 1.0% agarose by gel electrophoresis and the RNA was transferred to a charged nylon membrane (Ambion, Austin, Tex.). The RNA blots were hybridized with [α-³²P]dCTP random-primed mouse apoA5 and human APOAV probes in ULTRAhyb buffer (Ambion, Austin, Tex.). Probe templates were generated by PCR amplification of liver cDNA using degenerate primers degApoAV-F2-5′-GCGCGTGGTGGGRGAAGACA-3′ (SEQ ID NO:22) and degApoAV-R2-TCGCGCAGCTGGTCCAGGTT-3′ (SEQ ID NO:23). Filters were washed in 2×saline sodium citrate at room temperature for 20 minutes and in 0.1×SSC at 42° C. for 20 minutes, followed by autoradiography visualization.

The results of the RNA blots are described herein. (A) A mouse apoA5 cDNA probe was hybridized to a multi-tissue RNA blot from wild-type mice. Each lane contained one of eight mouse tissues (Clontech, Palo Alto, Calif.), respectively: 1, heart; 2, brain; 3, spleen; 4, lung; 5, liver; 6, skeletal muscle; 7, kidney; and 8, testis. The probes hybridized only to two transcripts approximately 1.3 and 1.9 kb in size in liver tissue (lane 5). (B) A human APOA5 cDNA probe was hybridized to a RNA blot containing eight human tissues (Clontech, Palo Alto, Calif.), respectively: 1, heart; 2, brain; 3, placenta; 4, lung; 5, liver; 6, skeletal muscle; 7, kidney; and 8, pancreas. The probes hybridized only to two transcripts approximately 1.3 and 1.9 kb in size in liver tissue (lane 5). (C) A human-specific APOA5 cDNA probe was hybridized to total RNA blots from human apoA5 transgenic mice and controls. Lane assignments are as follow: 1,5 transgenic liver; 2,6 transgenic intestine; 3,7 wild-type liver; 4,8 wild-type intestine. The probes hybridized only to two transcripts approximately 1.3 and 1.9 kb in size in transgenic liver tissue (lanes 1 and 5). (E) Northern blot analysis of various genotype mice using mouse APOAS probe following the apoA5 targeting event. Each lane contains liver mRNA from a wild-type (lane 1), heterozygous (lane 2) and homozygous knockout mouse (lane 3). To confirm similar amounts of RNA were loaded per lane, duplicate gels were examined by ethidium bromide staining. There was a large amount of transcript around 1.9-2 kb in lane 1 and a smaller band in lane 2 of same weight, while lane 3 showed no transcript.

EXAMPLE 2

Transgenic Non-Human Animals to Assess the Function of APOAV and apoAV

Restriction enzyme predictions for human genomic sequence (Genbank Accession Number AC007707) indicated that the entire human APOAV gene, but not neighboring genes, was contained within a 26 kbp XhoI DNA fragment (corresponding to approximately 1-27 kbp in FIG. 1B). BAC DNA corresponding to the clone sequenced from this region was prepared by standard alkaline lysis with a chromatography column (Qiagen, Valencia, Calif.), digested with the restriction enzyme XhoI and separated in 1% agarose by pulse-field gel electrophoresis. The 26 kbp XhoI DNA fragment containing human APOAV was purified using QIAEX II gel purification (Qiagen, Valencia, Calif.), adjusted to a final concentration of ˜1 ng/ml and micro-injected into fertilized FVB inbred mouse eggs using standard procedures. See K. A. Frazer, G. Narla, J. L. Zhang, E. M. Rubin, Nat Genet 9, 424-31 (1995).

Two founder transgenic mice were identified as determined by PCR amplification using primers hAPOA5-intrn-F1-5′-CCCGCTGCAGTCCCCAGAAT-3′ (SEQ ID NO:10) and hAPOA5-intrn-R1-5′-CAGGGTCGAGGGCTCTTGTCCT-3′ (SEQ ID NO:11). Each founder line was expanded by breeding to isogenic FVB strain mice (The Jackson Laboratory, Bar Harbor, Minn.).

The targeting construct to delete mouse apoA5 was built using PCR products amplified from BAC-RPCI-23-175F2 DNA (BACPAC Resources, Children's Hospital Oakland Research Institute). The first homology arm was PCR-amplified using primers containing introduced 5′ restriction sites for XbaI and EcoRI, respectively: mAV-XbaI-F1-5′-TGACTCTAGATACCCTTGGTCCCATGTTCCAGAT-3′ (SEQ ID NO:12) and mAV-EcoRI-R1-5′-CATTGAATTCGACAAGAGAAAGACGGGGCTCAAG-3′ (SEQ ID NO:13). The resulting 4.2 kbp PCR product was cloned into pXL-Topo (Invitrogen, Carlsbad, Calif.), DNA prepared by standard alkaline lysis (Qiagen, Valencia, Calif.) and digested with EcoRI according to the manufacturer's recommendations (New England Biolabs, Beverly, Mass.). A 4.2 kbp EcoRI fragment was gel-purified and cloned into the EcoRI site of the pPN2T vector to yield pPN2T-Arm1 (C. Paszty, et al., Nat Genet 11, 33-39 (1995)). Clones were PCR screened for inserts using the above described primers and positive clones were sequenced for proper orientation.

The second homology arm was PCR-amplified using primers mAV-NotI-F4-5′-TATGACTGCGGCCGCCACCAATCCCACATCTAAGCATCT-3′ (SEQ ID NO:14), containing an introduced 5′ NotI restriction site, and mAV-XhoI-R3-5′-GCTCGGTTCTGGGCACAGAGA-3′ (SEQ ID NO:15). The resulting 5.3 kbp PCR product containing an endogenous internal XhoI restriction site was digested with NotI and XhoI to yield a 5.1 kbp fragment which was directionally cloned into the XhoI and NotI sites of the pPN2T-Arm1 vector to yield final vector pPN2T-apoAV-KO. 129/SvJ ES cells (Incyte Genomics, Palo Alto, Calif.) were electroporated with 20 μg of the NotI linearized targeting construct and subsequently selected in 200 μg/ml G418 and 0.5 μg/ml FIAU for 8 days. Individual clones were isolated, expanded and screened by Southern blot analysis.

The external 3′ probe was amplified by PCR using primers mApoAV-3′ probe-F2-5′-CTTGAGGATGGGCATCAGCTGTAT-3′ (SEQ ID NO:16) and mApoAV-3′probe-R2-5′-GCTCACTAACAGCGCTCTTGCCT-3′ (SEQ ID NO:17). Targeted clones were injected into C57BL/6 blastocysts and chimeric males were bred to C57BL/6 females (The Jackson Laboratory, Bar Harbor, Minn.). Agouti offspring were tested for germline transmission of the targeted allele by PCR using primers specific to the neomycin gene (NeoF1-5′-CTTTTTGTCAAGACCGACCTG-3′ (SEQ ID NO:37) and NeoR1-5′-AATATCACGGGTAGCCAACGC-3′ (SEQ ID NO:38)) and heterozygous animals were intercrossed to obtain homozygous deletion animals for the mouse apoAS locus. Offspring were genotyped with PCR primers designed to the neomycin gene and with primers contained within the apoA5 deleted interval (mApoA5-F2-5′-ACAGTTGGAGCAAAGGCGTGAT-3′ (SEQ ID NO:18) and mApoA5-R2-5′-CTTGCTCGAAGCTGCCTTTCAG-3′ (SEQ ID NO: 19)). Properly targeted embryonic stems cells were identified using an external 3′ probe which detects a 17 kb EcoRI fragment wild-type allele and a 10 kb EcoRI fragment upon targeting.

EXAMPLE 3

Plasma Triglyceride and Cholesterol Levels for APOAV Transgenic and Knockout Mice

Referring now to FIG. 3, results from the present human APOAV transgenic mice and the apoAV knockout mice are shown. Plasma triglyceride and cholesterol levels for apoAV transgenic and knockout mice on standard chow diet are illustrated. (A) Human APOAV transgenic mice compared to isogenic FVB strain control littermates (n=48 for transgenics; n=44 for controls; student t-test *p<0.0001 for transgenic versus control) have a ˜70% decrease in triglyceride levels. (B) Mice lacking APOAV compared to mixed 129Sv/C57B16 strain controls littermates (n=13 for wild-type, +/+; n=22 for heterozygotes, +/−; n=10 for homozygous knockouts, −/−; student t-test **p<0.001 for wild-type versus knockout) have a 400% increase in triglyceride levels. Error bars correspond to the standard deviation for both graphs.

The transgenic mice had approximately three-fold lower levels of plasma triglyceride when compared with control littermates ((0.32±0.11 (S.D.) mg/ml versus 0.90±0.29; T-test p<0.0001). Similar data were obtained from a second independent founder line (data not shown).

Mice lacking apoA5 were compared to mixed 129Sv/C57B16 strain control littermates (n=13 for wild-type, +/+; n=22 for heterozygotes, +/−; n=10 for homozygous knockouts, −/−; student t-test **p<0.001 for wild-type versus knockout) (FIG. 3B). Despite the lack of apoA5 transcript, mice homozygous for the deletion were born at the expected Mendeliai rate and appeared normal. In contrast to the decreased triglyceride levels noted in APOAV transgenics, apoA5 knockout mice had approximately four-fold higher levels of plasma triglyceride when compared with wild-type littermates (1.53±0.77 (S.D.) mg/ml versus 0.37±0.12; T-test p<0.001) (FIG. 3B). Error bars correspond to the standard deviation for both graphs.

Characterization of lipoprotein particles by fast protein liquid chromotography revealed that levels of very low density lipoprotein (VLDL) particles were increased in the homozygous knockout mice and decreased in the transgenic mice compared with controls. VLDL levels in a heterozygous knockout mouse were intermediate between the homozygous knockout and control mouse. The peak VLDL elution volumes were similar in all animals, indicating comparable VLDL particle size, and levels of other lipoproteins were not significantly altered.

EXAMPLE 4

Genotyping Human Individuals

Blood samples were collected after a 5-hour fast by retro-orbital bleeding using heparinized micro-hematocrit tubes. Total cholesterol and triglyceride concentrations were measured using enzymatic methods on a Gilford System 3500 analyzer (Gilford Instruments, Oberlin, Ohio).

For the entire genomic sequence of APOAV, overlapping sequence-tagged sites (STSs) of 400-498 bp in size were designed and tested using PCR-amplification on human genomic DNA as previously described in E. M. Beasley, R. M. Myers, D. R. Cox, L. C. Lazzeroni, PCR Applications (Academic Press, San Diego, Calif., 1999). Only primer pairs that resulted in a single PCR product of expected size were used for subsequent amplifications. For SNP discovery, STSs were PCR-amplified from eight samples of the Polymorphism Discovery Resource panel (PDR08, Coriell Cell Repository, Camden, N.J.), and products were purified through Millipore plates according to the manufacturer's recommendations (Millipore, Bedford, Mass.). Subsequent sequencing reactions with purified PCR products were performed using Big Dye Terminator chemistry and forward or reverse primers in separate sequencing reactions (Applied Biosystems, Foster City, Calif.).

Reactions were analyzed using a 3700 Sequence Analyzer (Applied Biosystems, Foster City, Calif.). Sequence traces were automatically analyzed using PhredPhrap and Polyphred (D. A. Nickerson, V. O. Tobe, S. L. Taylor, Nucleic Acids Res 25, 2745-51 (1997); B. Ewing, P. Green, Genome Res 8, 186-94 (1998)). For SNPs identified through this analysis, PCR INVADER assays (Third Wave Technologies, Madison, Wis.) were designed and tested on 90 samples from the Polymorphism Discovery Resource panel (PDR90) (C. A. Mein, et al., Genome Res 10, 330-43 (2000)). Successful assays were subsequently used to analyze samples from our study. Genotypes were assigned automatically by cluster analysis. Differences among genotypes were analyzed by one way ANOVA using STATVIEW 4.1 software (Abacus Concepts, Inc., Berkeley, Calif.).

To genotype the C/T SNP3 polymorphisms upstream of APOAV (discussed in Example 5), oligonucleotides AV6-F-5′-GATTGATTCAAGATGCATTTAGGAC-3′ (SEQ ID NO:20) and AV6-R-5′-CCCCAGGAACTGGAGCGAAATT (SEQ ID NO:21) were used to amplify a 187 bp fragment from genomic DNA. The penultimate base in AV6-R was changed to T to create a MseI site (TTAA) in the common allele. The PCR reactions were performed in 20 μl volumes containing 50 mmol/l KCl, 10 mmol/l Tris (pH 8.3), 1.5 mmol/l MgCl₂, 0.2 mmol/l of each dNTP, 1 U of Taq, DNA polymerase and 200 pmol/l of each primer. DNA was amplified using the following conditions: initial denaturation of 96° C. for 2 min, followed by 32 cycles of 94° C. for 15 sec, 55° C. for 30 sec and 72° C. for 30 sec, and a final step at 72° C. for 3 min. 20 μls of PCR product were digested with 10 U of MseI (New England Biolab) at 37° C. for 3 h. The PCR products were size-fractionated on 3% agarose gels, stained with ethidium bromide and visualized on a UV transilluminator.

EXAMPLE 5

Human APOAV Polymorphisms and Lipid Association Studies

Referring now to FIG. 5, plasma lipid concentrations for a given genotype for four neighboring SNPs (SNPs1-4) are shown in Table 5A. For that study, 501 individuals were genotyped and the number of successfully scored individuals is approximately 430. The number of individuals of each SNP genotype is shown in row “n”. In the row labelled “Genotype,” 1,1=homozygous for the major allele; 1,2=heterozygous for the major and minor alleles. All individuals homozygous for the minor alleles of individual APOAV SNPs1-3 were removed from the analysis (n=2) to prevent their over-representation. All sites were found to be in Hardy-Weinberg equilibrium (data not shown). The minor allele frequency for each SNP (SNPs1-4) was 9.1, 8.4, 9.2 and 36.3%, respectively. Not shown is the lack of association between each of the four SNPs and IDL-, LDL-, HDL-mass, APOAI, and APOB levels (p>0.05, data not shown) FIG. 5B shows Pair-wise measure of linkage disequilibrium (|D′|) was calculated for all combinations of SNPs 1-4. A|D′| value of 1 indicates complete linkage disequilibrium between two markers. FIG. 5C shows a summary of SNP3 genotyping data from an independent set of individuals stratified based on triglyceride levels. P values were determined by Chi-square analysis. BMI=body mass index, TG=plasma triglyceride level (mg/dl±SEM).

Plasma lipid concentrations for a given genotype for four neighboring SNPs (SNPs1-4) are shown in FIG. 5A for triglycerides, VLDL, LDL and HDL. 501 unrelated normolipidemic Caucasian individuals who had been phenotyped for numerous lipid parameters before and after consumption of high- and low-fat diets were used in this study. Subjects were a combined subset of 501 healthy, nonsmoking Caucasian individuals aged >20 years (429 men, 72 women) who had participated in previous dietary intervention protocols (R. M. Krauss, D. M. Dreon, Am J Clin Nutr 62, 478S-487S (1995); D. M. Dreonet et al., Arterioscler Thromb Vasc Biol 17, 707-14 (1997)). All subjects had been free of chronic disease during the previous five years and were not taking medication likely to interfere with lipid metabolism. In addition, they were required to have plasma total cholesterol concentrations <6.74 mmol/L (260 mg/dL), triacylglycerol <5.65 mmol/L (500 mg/dL), resting blood pressure <160/105 mm Hg, and body weight <130% of ideal. Each participant signed a consent form approved by the Committee for the Protection of Human Subjects at EO Lawrence Berkeley National Laboratory, University of California, Berkeley, and participated in a medical interview. Fasting blood samples were obtained on their usual diets, and after 4-6 weeks of consuming diets containing high fat (35-46% energy) and low fat (20-24% energy). Plasma lipid and lipoprotein measurements were performed as previously described (R. M. Krauss, D. M. Dreon, Am J Clin Nutr 62, 478S-487S (1995); D. M. Dreonet al., Arterioscler Thromb Vasc Biol 17, 707-14 (1997)). In addition, on the high and low fat diets, total mass was measured by analytic ultra-centrifugation.

Significant associations were found between both plasma triglyceride levels and VLDL mass and the three neighboring SNPs (SNPs1-3) within APOAV but not with the distant upstream SNP4 (FIGS. 1A, 4A). Specifically, the minor allele of each of these SNPs (SNPs 1-3) was associated with higher triglyceride levels independent of diet. Independent analysis of each of these SNPs (SNP1-3) revealed plasma triglyceride levels were 20-30% higher in individuals having one minor allele compared to individuals homozygous for the major allele. Analysis of SNP allele frequencies in more than 1,000 chromosomes revealed that the three neighboring SNPs (SNPs1-3) in APOAV were in significant linkage disequilibrium that does not extend to SNP4 (located ˜11 kb upstream of APOAV). This finding supports the existence of a common haplotype in the APOAV region influencing plasma triglyceride levels (FIG. 4B). Furthermore, preliminary studies in this population found no significant association of triglyceride levels with a Sst1 polymorphism in APOC3 (located ˜40 kbp upstream of APOAV) which has been previously associated with severe hyper-triglyceridemia (See M. R. Hayden, et al., Am J Hum Genet 40, 421-30 (1987), M. Dammerman, et al., Proc Natl Acad Sci USA 90, 4562-6 (1993)). All individuals homozygous for the minor alleles of individual APOAV SNPs1-3 were removed from the analysis (n=2) to prevent their over-representation. All sites were found to be in Hardy-Weinberg equilibrium (data not shown). The minor allele frequency for each SNP (SNPs1-4) was 9.1, 8.4, 9.2 and 36.3%, respectively. No association between each of the four SNPs and IDL-, LDL-, HDL-mass, ApoAI, and ApoB levels (p>0.05) was observed.

Pair-wise measure of linkage disequilibrium (|D′|) was calculated for all combinations of APOAV SNPs as previously described by R. C. Lewontin, Genetics 120, 849-52 (1988). A |D′| value of 1 indicates complete linkage disequilibrium between two markers.

A summary of SNP3 genotyping data from an independent set of individuals stratified based on triglyceride levels. P values were determined by Chi-square analysis. BMI=body mass index, TG=plasma triglyceride level (mg/dl±SEM).

In a second human association study with SNP3 in an independently ascertained cohort using a different experimental design (FIG. 5C). SNP3 was chosen for genotyping in this study based on its strong association in our first study and its apparent complete linkage disequilibrium with the other two associated SNPs (SNPs 1-2). In the second study, we examined the allele frequencies for SNP3 in an unrelated group of Caucasians stratified according to plasma triglyceride levels. The two groups represented 115 individuals with triglyceride levels in the top tenth-percentile and 183 individuals from the bottom tenth-percentile. A significant over-representation of the heterozygous genotype (SNP3, APOA5*2) was found in individuals with high- compared to low-plasma triglyceride levels (18.3% versus 8.7%, respectively), thereby validating the effect in a second cohort. When the cohort was stratified based on gender, an even more pronounced over-representation of the heterozygous genotype was found in males with high- compared to low-plasma triglyceride levels (29.4% versus 5.2%, respectively).

Individuals that carry either of two independent SNPs described above have ˜30% higher triglyceride levels. Population-wide this effect is large. 25% of Caucasians, 36% of African-Americans, and 51% of Hispanics carry at least one copy of these two alleles associated with elevated triglycerides.

EXAMPLE 6

APOAV Haplotypes: Linkage Disequilibrium and Association Studies

The present Example describes methods for establishing genetic profiles of individuals carrying various alleles of the present APOAV gene. These methods rely on Linkage Analysis studies and result in the identification of haplotyes including the SNP's described in connection with FIG. 5. The haplotypes are illustrated in FIG. 4B and are APOA5*1, APOA5*2 and APOA5*3.

The present study protocols were approved by the appropriate institutional review boards. Fasting blood samples were obtained from i) 116 hyperlipidemic patients including 34 with Type III hyperlipidaemia, 10 with familial combined hyperlipidemia, 24 with LDL cholesterol levels exceeding the 90^(th) percentile, and 48 patients with plasma triglyceride levels exceeding 500 mg/dl; ii) 82 Caucasian men and 50 Caucasian women who were homozygous for the common allele of SNP3 (−1131T) and who had plasma triglyceride concentrations above the 90^(th) percentile for age and sex, and an equal number who were homozygous for the common allele of SNP3 (−1131T) and had plasma triglyceride concentrations below the 10^(th) percentile for age and sex; and iii) 2660 residents of Dallas County selected at random from census tracts who participated in the Dallas Heart Disease Prevention Project (DHDPP), a population-based study of atherosclerotic heart disease.

DNA samples were also obtained from healthy, nonsmoking, Caucasian men (n=354) and women (n=65) who had participated in previous dietary intervention protocols and had plasma cholesterol levels below 260 mg/dl and plasma triglyceride levels below 500 mg/dl.

DNA sequencing: The exons and flanking intron sequences of the APOAV gene were screened for sequence polymorphisms by DNA sequencing. DNA fragments of ˜400 basepairs spanning each exon were PCR amplified and sequenced using Big Dye Terminator Cycle Sequencing reagents on an ABI3100 automated sequencer.

SNP genotyping: The SNP5 (S19W) and V153M polymorphisms were assayed using PCR-RFLP and PCR INVADER assays (Third Wave Technologies, Madison, Wis.) as described previously. All PCR primers and probes used in biplex INVADER assays for this study are listed in Table 4. To assay the SNP5 polymorphism, oppositely-oriented oligonucleotides (AV1-F 5′ TGCTCACCTGGGCTCTGGCTCTTC (SEQ ID NO:24) and AV1-R 5′ CCAGAAGCCTTTCCGTGCCTGGGCGGC (SEQ ID NO:25)) were designed with a single nucleotide mismatch such that the C to G substitution that changes codon 19 from serine to tryptophan creates an Eag I site. PCR was performed in 20 μl volumes containing 50 mM KCl, 10 mM Tris (pH 8.3), 1.5 mM MgCl₂, 0.2 mM of each dNTP, 1 U of Taq DNA polymerase and 200 pM of each primer. Reactions were performed in a PTC-200 Thermal cycler (MJ Research, South San Francisco, Calif.) using an initial denaturation step of 96° C. for 2 min, followed with 30 cycles of 94° C. for 15 sec, 70° C. for 20 sec and 72° C. for 30 sec. The PCR products were digested for 3 hr at 37° C. with 7 U of Eag I (New England Biolabs, Beverly, Mass.) in buffer provided by the manufacturer and analysed by electrophoresis in 3% agarose gels. For the V153M polymorphism, genomic DNA was amplified using the oligonucleotides AV150-R 5′ TGGTGCACCACGAGGCTCTGCAGCAGTCCC (SEQ ID NO:26) and AV150-F 5′ AGGTGGCCCTGCGAGTGCAGGAGCTGC (SEQ ID NO:27) as described above, except that the annealing temperature was 67° C. PCR products were digested with Nla III and assayed by electrophoresis in 3% polyacrylamide gels.

The SNP3 polymorphism was analyzed by mass spectrometry using the MASSARRAY system (Sequenom Corporation, San Diego, Calif.) (Buetow et al. 2001, Proc. Natl. Acad. Sci. U.S.A 98 (2):581-584). The oligonucleotides used in biplex INVADER genotyping assays (Sequenom Corporation, San Diego, Calif.) are shown in Table 4 below and are SEQ ID NOS: 28-36. The polymorphisms SNP5, SNP6, and V153M (location shown in FIG. 4A) are available in dbSNP under accession numbers ss4383597, ss4383596, and ss4383598, respectively and in GenBank under rs3135506 (SNP5), rs651821 (SNP6), and rs3135507 (V153M).

TABLE 4 SNP Sequence SEQ ID NO: 28 SNP 6 Probe 1 ATG ACG TGG CAG ACG TAA TGG CAA GCA TGG C SEQ ID NO: 29 Probe 2 CGC GCC GAG GAT AAT GGC AAG CAT GGC SEQ ID NO: 30 Invader GCC TCC CTC CAC CTG TCT TCT CAG AGC AGT SEQ ID NO: 31 SNP5 Probe 1 ATG ACG TGG CAG ACG AAA ACG CTG TGG AGA G SEQ ID NO: 32 Probe 2 CGC GCC GAG GCA AAA CGC TGT GGA GAG SEQ ID NO: 33 Invader GCC TTT CCG TGC CTG GGT GGC CT SEQ ID NO: 34 V153M Probe 1 ATG ACG TGG CAG ACG TGG TGG GGG AAG AC SEQ ID NO: 35 Probe 2 CGC GCC GAG GAT GGT GGG GGA AGA C SEQ ID NO: 36 Invader AGG AGC TGC AGG AGC AGT TGC GCT

Statistical Analysis: Statistical analyses were carried out using the SAS computer program (Cary, N.C.). Plasma triglyceride concentrations were compared among different genotype groups using Wilcoxon's test. Allele frequencies were compared using Fisher's exact test. To determine pairwise linkage disequilibrium (LD) between SNPs, haplotype frequencies were estimated for 353 unrelated individuals using the Expectation-Maximization (EM) algorithm implemented in the computer program ARLEQUIN v. 2.0 (Excoffier and Slatkin, Mol. Biol Evol. 1995, 12 (5):921-927). The resulting frequencies were used to calculate the pairwise LD parameter D′ as discussed by Lewontin (Genetics 1988, 120 (3):849-852).

DNA sequencing: Screening of the coding regions and intron-exon boundaries of APOAV in 116 hyperlipidemic individuals revealed 10 new DNA sequence variations (FIG. 1A). An A to G substitution 3 nucleotides upstream of the initiation codon (SNP6) was found to be in strong linkage disequilibrium with three previously described polymorphisms (SNP1, SNP2, SNP3, FIG. 1A) that define the APOA5*2 haplotype which is associated with increased plasma triglyceride concentrations (Pennacchio et al., 2001 Science 294 (5540):169-173). The A to G substitution results in a conservative change in the predicted Kozak consensus sequence (SNP6) (Kozak 1991, J Cell Biol 115 (4):887-903; Kozak, Cell 1986, 44 (2):283-292). Two common nonsynonymous substitutions were also identified: A C→G substitution (SNP5) changed codon 19 from serine to tryptophan in 23 individuals, and a G→A substitution (c.457G>A) changed codon 153 from valine to methionine in 14 individuals. A third nonsynonymous substitution (c.944C>T) that changed codon 315 from alanine to valine was identified in two hyperlipidemic individuals. This conservative substitution did not co-segregate with hyperlipidemia in the family members of one of these individuals (data not shown) and was not found in 108 normolipidemic individuals, therefore no further studies of this polymorphism were undertaken. The other six polymorphisms, including three silent substitutions (c.132C>A, c.695C>G, c.738C>T), and three polymorphisms each found only in single individuals (IVS2+55G>C, and c. 1132C>T and c.1156 G>A in the 3′ UTR) were not evaluated further.

Allele frequency and Linkage Disequilibrium: Five polymorphisms were found to define three common haplotypes (denoted APOA5*1, APOA5*2, and APOA5*3) in 419 unrelated Caucasian individuals (FIG. 4B). These three haplotypes represented 82%, 8%, and 8% of the APOAV chromosomes examined, and thus comprise more than 98% of APOAV haplotypes in this population. APOA5*2 is distinguished from the common haplotype (APOA5*1) by four nucleotide substitutions (−1131T>C, c.−3A>G, IVS3+476G>T, and c.1259T>C) and shown to be associated with increased plasma triglyceride levels and named SNP3, SNP6, SNP5, SNP2 and SNP1 respectively. APOA5*3 is distinguished from the common haplotype by the substitution of G for C at nucleotide c.56 (codon 19 in the amino acid sequence). To determine the relative frequencies of the APOA5*2 haplotype in African-Americans and Hispanics, the −1131T>C SNP5 polymorphism was assayed in 1031 randomly selected individuals, including 545 African-Americans, 152 Hispanics, and 334 Caucasians. The allele frequency was significantly higher in African-Americans (0.12) and Hispanics (0.12), than in Caucasians (0.06, P<0.001). The frequency of the W19 allele (which defines haplotype APOA5*3) was similar in African-Americans (0.07) and Caucasians (0.06), but was substantially higher in Hispanics (0.15, P<0.001 compared to African-Americans).

Using this mathematical calculation specifically for SNP6 (APOA5*2) where the minor allele frequency is 6% in Caucasians, we find the distribution is 88% homozygous major, 11.6% heterozygous, 0.4% homozygous minor. Similarly, for SNP5(APOA5*3) the minor allele frequency is 6% for Caucasians, thus the distribution is 88% homozygous major, 11.6% heterozygous, 0.4% homozygous minor. Therefore, because SNP5 and SNP6 are independent of each other, 23.2% of the population is heterozygous (because 11.6%+11.6%=23.2%) and an additional 0.8% are homozygous for the minor allele. Thus, a large number (24%) of individuals in the general Caucasian population have elevated triglyceride levels solely due to the effect of APOAV polymorphisms.

In addition to APOAV's strong association with triglyceride levels in Caucasians, a strong effect is also seen African-Americans and Hispanics where the minor allele frequencies are higher. Thus, a larger percent of African-Americans and Hispanics display increased triglycerides due to the genetic effect of APOAV. Specifically, APOA5*2 and/or APOA5*3 are present in 36% of African Americans and 51% of Hispanics and results in an ˜25% increase in triglycerides compared to APOA5*1 homozygotes.

For SNP6 (APOA5*2) in Hispanics and African-Americans, the minor allele frequency is 12% thus the distribution is 77.4% homozygous major, 21.1% heterozygous, 1.4% homozygous minor. For SNP5 (APOA5*3) in Hispanics, minor allele frequency is 15%. Thus the distribution is 72% homozygous major, 25.5% heterozygous, 2.3% homozygous minor. For African-Americans, SNP5 (APOA5*3) minor allele frequency is 7% thus the distribution is 86.7% homozygous major, 13.0% heterozygous, 0.5% homozygous minor. Thus, for Hispanics 23.5% of individuals carry APOA5*2 and 27.8% carry APOA5*3 for a total of 51.3% of Hispanics carry minor versions of APOAV associated with increased triglycerides. Using a similar logic, 36% of African-Americans carry minor versions of APOAV associated with increased triglycerides.

Abnormalities in APOAV may be solely responsible for human genetic forms of cardiovascular disease (similar to APOE or APOAI) in certain families and individuals. By screening this gene in families with individuals segregating cardiovascular or other types of disease, causative mutations may be found. This would have important diagnostic implications as well as provide therapeutic entry points. Furthermore, the data indicate that alleles in this gene are associated with increased plasma triglyceride levels thereby likely predisposing large numbers of individuals to increased susceptibility to coronary artery disease. A second implication of our findings is that this gene has sequence variations or single nucleotide polymorphisms that correlate to increased susceptibility to cardiovascular disease. The minor alleles of the polymorphisms disclosed herein associated with triglycerides occur in approximately 25% of the Caucasian population, 36% of African-Americans and 51% of Hispanics, thus representing a significant cross-section of the population. There is an approximate 25% chance that a Caucasian person is heterozygous for one or both of the two rare haplotypes and individuals having this rare allele have 20-30% higher triglyceride levels. Furthermore, the present studies suggest that the rare allele at the SNP5 locus (or any polymorphism in linkage disequilibrium with it) may have a major impact on plasma triglyceride levels in those persons predisposed to hypertriglyceridemia. Therefore, finding and exploring the significance of DNA sequence polymorphisms in APOAV and its subsequent effect on plasma triglyceride levels in humans is another important diagnostic implication of this embodiment.

Association Studies: To test for association between the two common, nonsynonymous polymorphisms identified in this study (SNP5 and V153M) and plasma triglyceride concentrations, the allele frequencies at these loci were compared in Caucasian men and women who had plasma triglyceride concentrations above the 90^(th) percentile or below the 10^(th) percentile for age and sex. To eliminate confounding by the APOA5*2 haplotype that was previously associated with high plasma triglyceride levels, individuals who carried this haplotype were excluded. In both sexes, the rare allele at codon 19 (W19) was significantly more common in individuals with plasma triglyceride levels above the 90^(th) percentile than in those with plasma triglyceride levels below the 10^(th) percentile (Table 5). Since individuals with the SNP3 allele were excluded, the association between the S19W (SNP5) polymorphism and plasma triglyceride concentrations is independent of the APOA5*2 haplotype that was previously shown to be associated with increased plasma triglyceride levels (Pennacchio et al. 2001).

The study showing the relationship between gender, genotype and triglyceride levels looked at men and women with high (>90^(th) percentile) and low (<10^(th) percentile) plasma triglyceride concentrations and is shown below.

TABLE 5 APOAV genotype S19/S19 S19/W19 W19/W19 P value Men TG < 10^(th) percentile 74  7 1 <0.005 (n = 82)   (90.5)   (8.5) (1) Men TG > 90^(th) percentile 63 19 0 (n = 82) (77) (23) (0) Women TG < 10^(th) percentile 50  0 0 <0.001 (n = 50) (100)   (0) (0) Women TG > 90^(th) percentile 39 11 0 (n = 50) (78) (22) (0)

Values are numbers of individuals in each group. S19 is the common allele of SNP5. The percentage of individuals with the genotype is given in parentheses. All individuals were homozygous for the common alleles at SNPs 3, 6, 2 and 1, which means that all individuals with APOA5*2 haplotype were excluded. P values were calculated using Fisher's exact test.

To further assess this association, the SNP5 polymorphism was assayed in 419 healthy independently-ascertained Caucasians (354 men and 65 women). Baseline blood samples were obtained from these individuals on their self-selected diets, and additional samples were drawn following the consumption of a defined high-carbohydrate or high-fat diet. On all three diets, individuals who were heterozygous for the SNP5 (W19) allele and who lacked haplotype APOA5*2 had significantly higher plasma triglyceride concentrations than did individuals homozygous for the S19 (wild type) allele (Table 5).

The increase in mean plasma triglyceride levels associated with a single copy of the W19 allele was ˜36%, which is similar to the increase in triglyceride levels associated with APOA5*2 haplotype (˜32%) in these individuals. To determine if the W19 allele was associated with increased plasma triglyceride concentrations in other ethnic groups, the S19W polymorphism was assayed in a random sample of 1392 African-American, 420 Hispanic, and 848 Caucasians. In both sexes of all three ethnic groups, both the mean and the median plasma triglyceride concentrations were higher in W19 heterozygotes than in S19 homozygotes (Table 6 below). The difference was significant at the 0.05 confidence level for African-Americans and Caucasians in both sexes, but did not achieve the nominal significance threshold in Hispanics, presumably due to the smaller sample size in this group.

TABLE 6 Plasma triglyceride levels (mg/dl) S19/S19 S19/W19 W19/W19 P Value African- Mean ± S.D. 101 ± 169 131 ± 120 141 ± 50  0.0023 American Median ± I.Q. 80 ± 59 97 ± 85 192  Women range n (707) (108) (6) African- Mean ± S.D. 132 ± 152 176 ± 319 264, 84  0.024 American Median ± I.Q. 94 ± 84 111 ± 92  Men range n (494) (75) (2) Hispanic Mean ± S.D. 143 ± 95  174 ± 209 394 ± 534 0.057 Women Median ± I.Q. 119 ± 92  135 ± 99  214  range n (185) (57) (7) Hispanic Mean ± S.D. 173 ± 139 204 ± 182 206, 124 0.087 Men Median ± I.Q. 139 ± 108 157 ± 101 range n (119) (50) (2) Caucasian Mean ± S.D. 124 ± 96  147 ± 90  237, 125 0.012 Women Median ± I.Q. 100 ± 87  122 ± 110 range n (386) (54) (2) Caucasian Mean ± S.D. 161 ± 121 255 ± 225 0.0012 Men Median ± I.Q. 126 ± 116 183 ± 237 range n (362) (44) (0)

The nucleotide substitution (c. 457G>A, ) that changed codon 153 from valine to methionine was less common in men with high plasma triglyceride levels (3/82) than in men with low plasma triglyceride levels (7/82), but this difference was not statistically significant (P=0.12, Fisher's exact test). In 388 healthy Caucasian individuals, the mean plasma triglyceride level of 457G homozygotes was similar to that observed in 457GA heterozygotes (126.2±4.2 mg/dL (n=363) and 113.3±12.7 mg/dL (n=25), respectively, p=0.43).

EXAMPLE 7

Haplotype Linkage of APOAV Rare Alleles to Hyperlipidemia (CHL) and Familial Combined Hyperlipidemia (FCHL) Diseases

Familial combined hyperlipidemia (FCHL) is a common disorder of lipid metabolism affecting 1-2% of individuals in Western society. The term FCHL was coined by Goldstein et al (1973) to describe a pattern of lipid abnormalities in 47 Seattle pedigrees, ascertained through survivors of myocardial infarction who had raised blood cholesterol and triglyceride levels. Herein, APOAV allele SNP6 (c.56G) is shown to have an increased transmission in affected FCHL members from large pedigrees.

This example involves linkage and linkage disequilibrium (LD) tests on the APOA1/C3/A4/A5 genomic interval in a substantial cohort of white British families with FCHL. The results show that the transmission of FCHL in a subset of these families is linked to the transmission of two independent haplotypes in the APOA1/C3/A4/A5 genomic interval. The first haplotype contains the rare allele at the SNP5 locus and a second the rare allele at the APOC3^(c.386C>G) locus within the APOC3 (or “APOCIII”) gene.

To establish the contribution of allelic variation at the APOA1/C3/A4/AS genomic interval to FCHL susceptibility, linkage and LD tests were performed on a cohort of white British families. For the linkage test, 86 extended families were genotyped with two markers: D11SAPOC3 which resides within the third intron of the APOC3 gene, and D11S1998, which is located approximately 1.7 Mbp downstream of the APOAV gene (FIG. 1). The families contained 177 and 270 affected relative pairs for the CHL phenotype and the triglyceride trait of FCHL, respectively. The D11SAPOC3 marker produced nominal evidence for linkage (NPL⁺ 1.72, P=0.042) of the chromosome 11q23 genomic region to the triglyceride trait of FCHL, and this was attributable to an excess of allele sharing in the affected pedigree members of a subset (i.e. 35) of the 86 families.

To substantiate evidence for linkage of the APOA1/C3/A4/A5 genomic interval to FCHL, we performed a PDT on 115 white British families using seven SNPs that span an interval of 108 Kbp, followed by a case-control study involving 181 white British probands and 268 pedigree founders. The “PDT,” pedigree disequilibrium test, is described at “A Test for Linkage and Association in General Pedigrees: The Pedigree Disequilibrium Test” by Martin E R, Monks S A, Warren L L, and Kaplan N L. Am J Hum Genet 67:146-154, 2000. For a discussion of the SNP naming conventions used in this Example, see Antonarakis et al. “Recommendations for a nomenclature System for Human Gene Mutations,” Human Mutation 11:1-3 (1998).

The SNPs are named using the annotation described previously, “IVS” means that the SNP is positioned in the intervening sequence, “c” means the SNP is positioned in the coding sequence, “−” indicates the location is upstream by a specified number of base pairs, and “+” indicates that the location is downstream by a specified number of base pairs.

The SNPs included two SNPs within the APOAV gene (SNP5 (APOA5^(c.56C>G)) and SNP6 (APOA5^(c.−3A>G))), a noncoding SNP within the APOC3 gene (APOC3^(c.386C>G)), three SNPs upstream of the APOAV locus (SNP3 (APOA5^(−1,131T>C)), SNP4 (APOA5^(−12,238T>C)), and APOA1^(−3031C>T)) and one SNP (APOA5^(58,892C>T)) downstream of APOAV.

The results of the PDT produced evidence for increased transmission of the rare alleles at the SNP5 and APOC3^(c.386)C>G loci to affected subjects. For example, the rare alleles at the SNP5 and APOC3^(c.386C>G) loci were respectively transmitted 1.95- and 1.45-fold more frequently to affected family members with the triglyceride trait of FCHL than an unaffected child individuals. The corresponding values for the CHL trait were 1.95 and 1.33, respectively. The rare alleles at the SNP6 and SNP3 loci were also transmitted 1.28 and 1.40 fold-more frequently to affected individuals with the CHL phenotypes of FCHL than to unaffected individuals (P=0.039 and 0.033).

The rare alleles at the SNP5, APOC3^(c.386C>G), SNP3 and SNP6 loci were also present at increased frequencies in FCHL probands versus pedigree founders (i.e. “married ins”). For example, the rare allele at the SNP5 locus was present in 21% of the probands compared to 13% of the normolipidemic pedigree founders, whereas the rare allele at the APOC3^(c.386c>G) locus was present in 29% of the probands and 15% of the normolipidemic pedigree founders. Importantly, the results from this case-control study and the PDT complemented each other. For the example, the frequencies of the rare alleles at the SNP5, SNP6, SNP3 and APOC3^(c.386C>G) loci in FCHL probands and affected FCHL sibs were remarkably similar (i.e. 0.1200, 0.1144, 0.1111 and 0.1486, respectively versus 0.1114, 0.1156, 0.1296 and 0.1566). Likewise, the frequencies of the rare alleles at the SNP6 and APOC3^(c.386C>G) loci were similar in the pedigree founders and unaffected sibs (0.0694 and 0.1024, respectively versus 0.0511 and 0.1048) (Table 2). Thus, the case-control data support the evidence that the rare allele at SNP5 (APOA5^(c.56G)) and APOC3^(c.386G) alleles (or alleles in LD) are preferentially transmitted in FCHL.

Probands with the rare allele at SNP5 (APOA5^(c.56G)) had higher mean triglyceride levels than probands homozygous for the major allele at this locus, and this was particularly evident in those individuals that were homozygous for this rare allele (n=5). Thus, mean plasma triglyceride levels in probands with the APOA5^(c.56G) allele were on average 2.2 fold higher than in probands homozygous for the common SNP5 (APOA5^(c.56C)) allele, and ˜1.8 fold higher relative to the heterozygote probands. By contrast, the APOA5^(c.56G) allele had no major impact on triglyceride levels in heterozygote pedigree founders, and this was also the case when all individuals with the rare allele at the APOC3^(c.386C>G) locus were excluded from the analyses (data not shown). Only one pedigree founder was homozygous for the APOA5^(c.56G) allele, precluding an assessment of the impact of the homozygous state of this allele (or an allele in LD) on plasma triglyceride in the pedigree founders of white British families with FCHL.

The APOC3^(c.386G) allele (or an allele in LD) had a modest impact on triglyceride levels in probands and pedigree founders. On average pedigree founders with the APOC3^(c.386G) allele had plasma triglyceride levels that were 31% higher than pedigree founders without this allele (P=0.001), and this increased to a value of 38% (P=0.001) when we considered only those individuals with the common allele at the SNP5 locus (data not shown). Similar increases in plasma triglyceride levels were also observed in pedigree founders with the rare alleles at the SNP3 and SNP6 loci (data not shown). In a complementary analysis, increased frequencies of these rare alleles were observed in pedigree founders that had plasma cholesterol and triglyceride levels >75^(th) percentile age-sex-specific values relative to the rest. This trend was not observed for the rare allele at the APOA5^(c.56C)>G locus, indicating that this allele resides on a different APOA1/C3/A4/A5 haplotype than the rare alleles at the APOC3^(c.386C>G) and SNP3 and SNP6 loci.

To further test for preferential transmission of the APOA5^(c.56G) and APOC3^(c.386G) alleles in FCHL, a second study repeated the PDT in families with haplotype data for the APOA1/C3/A4/A5 genomic interval. The distorted transmission of the rare allele at the SNP5 locus in FCHL was restricted to the 35 families that produced evidence for linkage of the chromosome 11q23 locus to FCHL (P=0.0133), suggesting that a major component of this observed linkage may be explained by this allele, or a polymorphism in LD with it or a linked allele. By contrast, the rare alleles at the APOA5^(58892C>T), SNP6, SNP3 and APOC3^(c.386C>G) loci were only modestly over-transmitted in the 35 families that had contributed to the nominal evidence of linkage of FCHL to chromosome 11q23 (P=0.0423, 0.12, 0.19, 0.079, respectively), indicating supporting that these alleles, or alleles in LD with them, may have contributed at most very modestly effects to the observed linkage signal.

The results of the case-control study, included genotype data from 181 white probands and 268 pedigree founders, and essentially mirrored the results of the PDT. Thus, the frequencies of the rare alleles at the SNP5, APOC3^(c.386C>G), SNP3 and SNP6 loci were increased in FCHL probands versus pedigree founders. For example, the rare allele at the SNP5 locus was present in 21% of the probands compared to 13% of the normolipidemic pedigree founders (P=0.01), whereas the rare allele at the APOC3^(c.386C>G) locus was present in 29% of the probands and 14.8% of the normolipidemic pedigree founders (P=0.01). The corresponding values for the rare alleles at the SNP3 and SNP6 loci were 20.5% and 6.4% (P=0.001), and 21.6% and 8.6% (P=0.001), respectively.

Probands with the rare allele at the SNP5 locus had higher mean triglyceride levels than probands homozygous for the major allele at this locus, and this was particularly evident in those individuals that were homozygous for this rare allele. Thus, mean plasma triglyceride levels in probands with the rare allele at the SNP5 locus were on average 2.2 fold higher than in probands homozygous for the common allele at this locus, and ˜1.8 fold higher than those found in the heterozygote probands. By contrast, the rare allele at the SNP5 locus had no major impact on triglyceride levels in heterozygote pedigree founders, and this was also the case when all individuals with the rare allele at the APOC3^(c.386C>G) locus were excluded from the analyses. Only one pedigree founder was found to be homozygous for the rare allele at the SNP5 locus, and this has precluded us from establishing the impact of the homozygous state of this allele (or polymorphisms in LD with it) on plasma triglyceride in the pedigree founders. Nonetheless, the inventors suggest that the rare allele at the SNP5 locus (or any polymorphism in LD with it) may have a major impact on plasma triglyceride levels in those persons predisposed to hypertriglyceridemia.

EXAMPLE 8

Modulating and Regulating APOAV Expression with Drugs

A. Human APOAV Gene Expression Induced by Fibrates Treatment

Fibrates are described at Miller D B, Spence J D. “Clinical pharmacokinetics of fibric acid derivatives (fibrates). Clin Pharmacokinet 1998; 34(2):155-62. To determine whether fibrates can modulate APOAV gene expression in humans, first, analyze APOAV mRNA levels in primary hepatocytes upon treatment with a fibrate such as fenofibric acid, the active form of fenofibrate, which is a prototype of PPARα ligands. Observe whether treatment with fenofibric acid at a concentration (100 μM) similar to that reached in plasma from patients treated with fenofibrate dramatically increases APOAV mRNA levels. These observations could demonstrate that fibrates induce the expression of the human APOAV, thus supporting the use of APOAV as a new target gene for fibrates. In general, a drug candidate may be tested in cells or animals and the effect of that drug on levels of APOAV mRNA and/or protein observed. Drug candidate which increase such levels have utility as agents which may lower cholesterol and triglyceride levels in appropriate subjects. As described in connection with Example 9, a drug candidate may also have insulin modulating properties which can be measured through the effect of a drug candidate on protein and/or mRNA levels of APOAV in a test animal or cell. Furthermore, which it is shown by the present work that increased levels of APOAV are associated with lowered levels of triglycerides and cholesterol, for individuals having deleterious alleles, lowering APOAV levels may be beneficial.

B. Fenofibrate Regulation of apoA5 Expression Via PPARα Activation

Next, one could examine whether PPARα is involved in the regulation of apoa5 by fibrates. Apoa5 mRNA levels could be strongly enhanced in the liver of wild-type mice after treatment with fenofibrate mixed in diet (0.2% w/w). These experiments would show that apoa5 expression is induced by fibrates in vivo in mouse liver and its regulation may largely depend on PPARα activation.

C. Gene Regulation of APOAV by Fibrates at the Transcriptional Level

To delineate the mechanism of regulation of APOAV gene expression by fibrates, functional analysis of the APOAV promoter is necessary. Host cells, such as HepG2 cells, can be transiently transfected with a Luciferase reporter vector driven by the human APOAV promoter and challenged with a PPARα activator. Transcriptional activity of the APOAV reporter construct can be observed for increase in levels after addition of the activator. Co-transfection with PPARα may also have the effect of strongly stimulating APOAV promoter activity. Such results would indicate that the gene regulation of APOAV by fibrates occurs at the transcriptional level.

D. APOAV Responsiveness to PPARα or PPARγ

Transcriptional activation of APOAV gene by PPARα would suggest the presence of a peroxisome proliferator-activated response elements (PPRE) in the APOAV promoter sequence. Comparative sequence analysis of the murine and human APOAV promoters can be performed to reveal the presence of any regions of cross-species conservation containing putative PPREs with a high degree of homology between the putative PPREs and the PPRE consensus defined for PPARs.

To assess whether the putative PPREs mediate any PPARα or PPARγ effects, one should perform transfection experiments using a promoter construct containing mutated versions of any PPREs found. If mutation of any PPREs found abolishes activation of the APOAV promoter by PPARα this would indicate that the human APOAV promoter contains PPREs that act to mediate PPAR action.

EXAMPLE 9

APOAV Expression Levels and Their Effect Upon Human Insulin Levels

Significant differences in plasma triglyceride concentrations in APOAV genetically engineered animals prompted study to determine if alterations in APOAV expression led to changes in plasma glucose or insulin levels as well. Significant differences were also found for plasma insulin but not glucose levels. APOAV transgenic mice were found to have ˜80% higher insulin levels than controls, compared to ˜220% lower insulin levels in apoA5 knockouts compared to controls. P-values were calculated based on student T-tests. Plasma glucose levels were also examined and no differences were found. Their levels were 173, 166, 132, and 130 mg/dL in ApoA5 transgenics, littermate controls, apoA5 knockouts, and littermate controls, respectively.

TABLE 7 Plasma Triglyceride and Insulin Concentrations in ApoA5 Transgenic, ApoA5 Knockout and Littermate Control Mice Insulin Triglycerides ng/ml (S.E.M.) p value (S.E.M.) p value Control (FVB) 152.9 (±6.3) 0.000015 0.9 (±0.07) 0.01 APOA5 90 (±7.6) 1.6 (±0.29) Transgenic (FVB) Control 150.3 (±26.1) 0.025 2 (±0.16) 0.0000006 (C57B16/129Sv) ApoAV Knockout 245.9 (±41.0) 0.9 (±0.06) (C57B16/129Sv)

The fact that both transgenic and knockout mice shown differences in insulin but not glucose levels indicate alterations in the function of insulin in these two models. For instance the finding of high triglycerides in APOAV transgenic (yet unchanged glucose levels) supports the hypothesis that these animals are insulin resistant.

These findings suggest that APOAV may plan an important role in metabolic syndrome, insulin resistance, obesity, and diabetes. In addition, they support that therapies directed at modulating APOAV levels or course of action may be useful for treating these common conditions in humans.

Thus there has been described in detail the making and use of the preferred embodiments of the present invention. In view of the present teachings, numerous alternatives and variations may be envisioned by one of ordinary skill in the field. Thus it is intended that the scope of protection for the present invention be limited only by the scope of the appended claims. 

1. An isolated APOAV polypeptide having the amino acid sequence set forth in SEQ ID NO:
 7. 2. A composition for lowering plasma triglycerides comprising a polypeptide having at least 70% homology to the polypeptide of claim 12 and a pharmaceutically acceptable excipient.
 3. An antibody that specifically binds to a polypeptide according to claim
 12. 4. The antibody of claim 3, wherein the antibody specifically binds to an epitope comprising position 19 of SEQ ID NO:7.
 5. A polynucleotide encoding the polypeptide according to claim
 1. 6. The composition of claim 2, wherein the polypeptide has at least 95% homology to the polypeptide of claim
 12. 